Organization
MEDIGROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK WEINER M.D. (OWNER)
(781) 986-1737
Entity
Organization
Contact information
Practice address
4 FRANK LEARY WAY, RANDOLPH, MA 02368-4512
(781) 986-1737
(781) 986-0507
Mailing address
4 FRANK LEARY WAY, RANDOLPH, MA 02368-4512
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
54262
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9725288
—
MA
Enumeration date
08/23/2006
Last updated
09/10/2007
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