| Mystic Medical Group, Inc. | |
|
170 Governors Ave Medford MA 02155-1643 | |
| (781) 391-4106 | |
| (781) 391-3043 |
| Full Name | Mystic Medical Group, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 170 Governors Ave, Medford, Massachusetts |
| Authorized Official Name and Position | Robert S Weinstein (PRESIDENT) |
| Authorized Official Contact | 7813910801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Medical Group, Inc. 170 Governors Ave Medford MA 02155-1643 Ph: (781) 391-0801 | Mystic Medical Group, Inc. 170 Governors Ave Medford MA 02155-1643 Ph: (781) 391-4106 |
| NPI Number | 1245218676 |
|---|---|
| Provider Enumeration Date | 01/05/2006 |
| Last Update Date | 10/21/2010 |
| Medicare PECOS PAC ID | 1456326321 |
|---|---|
| Medicare Enrollment ID | O20040902000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245218676 | NPI | - | NPPES |
| 688708 | Other | TUFTS GROUP | |
| M17957 | Other | BLUE CROSS GROUP |
| Provider Name | Robert S Weinstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801887831 PECOS PAC ID: 5799720835 Enrollment ID: I20050719000792 |
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