Provider Demographics
NPI:1841678869
Name:MEDEVAL, CORP.
Entity type:Organization
Organization Name:MEDEVAL, CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCHACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-943-0570
Mailing Address - Street 1:495 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3928
Mailing Address - Country:US
Mailing Address - Phone:617-943-0570
Mailing Address - Fax:
Practice Address - Street 1:9 GERMAY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1155
Practice Address - Country:US
Practice Address - Phone:781-382-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty