Provider Demographics
NPI:1992701312
Name:ADULT MEDICINE PHYSICIANS, LLC
Entity type:Organization
Organization Name:ADULT MEDICINE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEITAO-PINA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:508-368-3030
Mailing Address - Street 1:100 CENTRAL STREET, 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608
Mailing Address - Country:US
Mailing Address - Phone:508-363-3616
Mailing Address - Fax:508-363-0607
Practice Address - Street 1:100 CENTRAL ST
Practice Address - Street 2:STE 4
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-363-3616
Practice Address - Fax:508-363-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M21386Medicare ID - Type Unspecified