Provider Demographics
NPI:1952384075
Name:MARSEGLIA, RICHARD V (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:V
Last Name:MARSEGLIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:225 LEOMINSTER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-2148
Practice Address - Country:US
Practice Address - Phone:978-422-6900
Practice Address - Fax:978-422-7561
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2035260Medicaid
MA2035260Medicaid
MAG69836Medicare UPIN