Individual
MITCHELL A MEDOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 MASSACHUSETTS AVE, CROSSTOWN 6C, BOSTON, MA 02118-2605
(617) 414-5951
(617) 414-9201
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
234299
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110078677A
—
MA
Enumeration date
04/12/2006
Last updated
05/09/2019
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