| Vineyard Personalized Medicine Llc | |
|
24 Cournoyer Rd West Tisbury MA 02575 | |
| (508) 693-1300 | |
| (508) 693-1305 |
| Full Name | Vineyard Personalized Medicine Llc |
|---|---|
| Speciality | General Practice |
| Location | 24 Cournoyer Rd, West Tisbury, Massachusetts |
| Authorized Official Name and Position | Lisa Nagy (SOLE PROPRIETOR) |
| Authorized Official Contact | 5086931300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vineyard Personalized Medicine Llc 24 Cournoyer Rd Vineyard Haven MA 02568-7625 Ph: (508) 693-1300 | Vineyard Personalized Medicine Llc 24 Cournoyer Rd West Tisbury MA 02575 Ph: (508) 693-1300 |
| NPI Number | 1275894875 |
|---|---|
| Provider Enumeration Date | 05/31/2012 |
| Last Update Date | 11/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275894875 | NPI | - | NPPES |
| 11009334A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 72590 (Massachusetts) | Primary |