Provider Demographics
NPI:1194267351
Name:MEADOWBROOK MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:MEADOWBROOK MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MADUAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-826-4744
Mailing Address - Street 1:19 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2669
Mailing Address - Country:US
Mailing Address - Phone:508-826-4744
Mailing Address - Fax:508-853-6226
Practice Address - Street 1:354 W BOYLSTON ST STE 226-228
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2373
Practice Address - Country:US
Practice Address - Phone:774-261-8682
Practice Address - Fax:774-261-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty