| Mystic Valley Medical Associates Inc. | |
|
101 Main St Suite 110 Medford MA 02155-4540 | |
| (781) 396-4514 | |
| (781) 395-4778 |
| Full Name | Mystic Valley Medical Associates Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 Main St, Medford, Massachusetts |
| Authorized Official Name and Position | Bing Ho Ko (PRESIDENT) |
| Authorized Official Contact | 7813964514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Valley Medical Associates Inc. 101 Main St Suite 110 Medford MA 02155-4540 Ph: (781) 396-4514 | Mystic Valley Medical Associates Inc. 101 Main St Suite 110 Medford MA 02155-4540 Ph: (781) 396-4514 |
| NPI Number | 1275579179 |
|---|---|
| Provider Enumeration Date | 06/21/2006 |
| Last Update Date | 07/23/2007 |
| Medicare PECOS PAC ID | 5294835260 |
|---|---|
| Medicare Enrollment ID | O20070705000614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275579179 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 59608 (Massachusetts) | Primary |
| Provider Name | Jill Lococo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568689628 PECOS PAC ID: 7911971890 Enrollment ID: I20040825001028 |
| Provider Name | Bing H Ko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053385302 PECOS PAC ID: 1456377027 Enrollment ID: I20051022000120 |
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