Provider Demographics
NPI:1275367591
Name:MAESTRO MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:MAESTRO MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:TABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-512-5659
Mailing Address - Street 1:8 HIAWATHA TRL
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-3320
Mailing Address - Country:US
Mailing Address - Phone:603-512-5659
Mailing Address - Fax:
Practice Address - Street 1:250 SHEARER ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1428
Practice Address - Country:US
Practice Address - Phone:603-512-5659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty