Organization
MYSTICK WOMEN'S HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN MARIE GUTHRIE MD (PRESIDENT)
(781) 395-1110
Entity
Organization
Contact information
Practice address
13 BRADLEE RD, MEDFORD, MA 02155-3110
(781) 395-1110
(781) 395-8553
Mailing address
13 BRADLEE RD, MEDFORD, MA 02155-3110
(781) 395-1110
(781) 395-8553
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
60673
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9711601
—
MA
Enumeration date
09/28/2006
Last updated
12/30/2011
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