Provider Demographics
NPI:1588074769
Name:TAK MEDICAL GROUP, PC
Entity type:Organization
Organization Name:TAK MEDICAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-728-4455
Mailing Address - Street 1:48 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2134
Mailing Address - Country:US
Mailing Address - Phone:978-728-4455
Mailing Address - Fax:978-751-8546
Practice Address - Street 1:120 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MA
Practice Address - Zip Code:01469-1128
Practice Address - Country:US
Practice Address - Phone:978-597-8166
Practice Address - Fax:978-597-0061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAK MEDICAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-28
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty