Provider Demographics
NPI:1063690337
Name:MEDEIROS, MAUREEN R (LMT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:R
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 ACUSHNET AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-3932
Mailing Address - Country:US
Mailing Address - Phone:508-726-2233
Mailing Address - Fax:
Practice Address - Street 1:83 BROOKLAWN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-5628
Practice Address - Country:US
Practice Address - Phone:508-726-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT-00290-MT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist