# MAIN STREET FAMILY PRACTICE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598739526
- **Authorized official:** TIMOTHY ARTHUR TIERNEY M.D., (PRES.)
- **Authorized official phone:** (781) 662-4934

## Contact information

- **Practice address:** 675 MAIN ST, MELROSE, MA 02176-3138
- **Practice address phone:** (781) 662-4934
- **Practice address fax:** (781) 662-4711
- **Mailing address:** 675 MAIN ST, MELROSE, MA 02176-3138
- **Mailing address phone:** (781) 662-4934
- **Mailing address fax:** (781) 662-4711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/15/2006
- **Last updated:** 02/24/2011