Organization
DEDHAM MEDICAL ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD M RUSSO (CFO)
(781) 278-5540
Entity
Organization
Contact information
Practice address
1 LYONS ST, DEDHAM, MA 02026-5599
(781) 329-1400
(781) 278-5667
Mailing address
PO BOX 9120, DEDHAM, MA 02027-9120
(781) 329-1400
(781) 278-5667
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9766529
—
MA
05
—
9766537
—
MA
05
—
9766545
—
MA
05
—
9766553
—
MA
05
—
9766561
—
MA
05
—
9766588
—
MA
05
—
9766596
—
MA
05
—
9766618
—
MA
05
—
9766626
—
MA
05
—
9766634
—
MA
Enumeration date
07/29/2005
Last updated
07/21/2022
Update your record
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