Basic Information
| Provider Information | |||||||||
| NPI: | 1033651104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MEDICAL ALLIANCE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 SUMMER ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022101114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888978947 | ||||||||
| FaxNumber: | 6175261909 | ||||||||
| Practice Location | |||||||||
| Address1: | 253 SUMMER ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022101114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888978947 | ||||||||
| FaxNumber: | 6175261909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2016 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | SHIROSKY | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6177725690 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEIGHBORHOOD HEALTH PLAN | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2281236 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.