Provider Demographics
NPI:1881698520
Name:A-ONE SPECIALTY MEDICAL LLC
Entity type:Organization
Organization Name:A-ONE SPECIALTY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-977-9444
Mailing Address - Street 1:58 MYRICKS ST
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1809
Mailing Address - Country:US
Mailing Address - Phone:508-977-9444
Mailing Address - Fax:508-977-9494
Practice Address - Street 1:58 MYRICKS ST
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-1809
Practice Address - Country:US
Practice Address - Phone:508-977-9444
Practice Address - Fax:508-977-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4576240001Medicare NSC