Organization
MGPO
Active
Organization
MGPO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY A MILLER (ENROLLMENT SPECIALIST, MGPO)
(617) 724-7168
Entity
Organization
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-7168
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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