Organization
HALLMARK HEALTH MEDICAL ASSOCIATES INC
Active
Parent organization
HALLMARK HEALTH COPORATION
Other names
Ell Pond Medical Associates Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
HALLMARK HEALTH COPORATION
Authorized official
MR. MICHAEL S TURILLI (VICE PRESIDENT FISCAL SERVICES)
(781) 338-7415
Entity
Organization
Contact information
Practice address
170 GOVERNORS AVE, ATTN: PROVIDER ENROLLMENT, MEDFORD, MA 02155-1643
(781) 338-7521
(781) 338-7531
Mailing address
PO BOX 3237, WOBURN, MA 01888-3237
(781) 338-7170
(781) 338-7173
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VX0201X
Gynecologic Oncology Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9771336
—
MA
01
—
M15828
BLUE CROSS GROUP PROV #
MA
Enumeration date
01/23/2006
Last updated
11/18/2009
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