MYSTIC MEDICAL GROUP INC. NPI 1245218676

NPI Information

MYSTIC MEDICAL GROUP, INC. is a pulmonary disease internal medicine in Medford, MA. The provider is an internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. MYSTIC MEDICAL GROUP, INC. NPI is 1245218676. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

170 GOVERNORS AVE
MEDFORD, MA
ZIP 02155-643
Phone: (781) 391-4106
Fax: (781) 391-3043

The provider's authorized official is Robert S Weinstein .
The authorized official title is President and has the following contact phone number (781) 391-0801.

The CLIA number assigned to this NPI record is 22D0999932 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2006 and was last updated on 10/21/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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