Basic Information
| Provider Information | |||||||||
| NPI: | 1134337116 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RELIANT MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 GOLD STAR BLVD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569510 | ||||||||
| FaxNumber: | 5088531907 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 GOLD STAR BLVD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569510 | ||||||||
| FaxNumber: | 5088531907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | ELSAWY | ||||||||
| AuthorizedOfficialFirstName: | TAREK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5088520600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RELIANT MEDICAL GROUP, INC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.