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Organization
MYSTIC MEDICAL GROUP, INC.
Active
Organization
MYSTIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT S WEINSTEIN M.D. (PRESIDENT)
(781) 391-0801
Entity
Organization
Contact information
Practice address
170 GOVERNORS AVE, MEDFORD, MA 02155-1643
(781) 391-4106
(781) 391-3043
Mailing address
170 GOVERNORS AVE, MEDFORD, MA 02155-1643
(781) 391-0801
(781) 391-3793
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
NULL
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Enumeration date
01/05/2006
Last updated
10/21/2010
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