| Miray Medical Corp | |
|
348 N Pearl St Brockton MA 02301-1197 | |
| (508) 586-8012 | |
| (508) 583-2779 |
| Full Name | Miray Medical Corp |
|---|---|
| Speciality | Internal Medicine |
| Location | 348 N Pearl St, Brockton, Massachusetts |
| Authorized Official Name and Position | Renolt Samaan (PRESIDENT) |
| Authorized Official Contact | 5085868012 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Miray Medical Corp 348 N Pearl St Brockton MA 02301-1197 Ph: (508) 586-8012 | Miray Medical Corp 348 N Pearl St Brockton MA 02301-1197 Ph: (508) 586-8012 |
| NPI Number | 1396940573 |
|---|---|
| Provider Enumeration Date | 06/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396940573 | NPI | - | NPPES |
| 9768033 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 71989 (Massachusetts) | Primary |
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