Provider Demographics
NPI:1962569848
Name:RESIL MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:RESIL MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-298-8304
Mailing Address - Street 1:PO BOX 366251
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-0023
Mailing Address - Country:US
Mailing Address - Phone:617-298-8304
Mailing Address - Fax:617-298-8300
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SETON MEDICAL BUILDING, SUITE 205
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-298-8304
Practice Address - Fax:617-298-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110067981AMedicaid
MA110076362AMedicaid
MA9714405Medicaid
MAH13912Medicare UPIN
MAM21140Medicare ID - Type Unspecified