Provider Demographics
NPI:1447465158
Name:MEDICAL PROFESSIONAL SERVICES, INC.
Entity type:Organization
Organization Name:MEDICAL PROFESSIONAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:POURSHADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-397-9980
Mailing Address - Street 1:388 PLEASANT ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-8143
Mailing Address - Country:US
Mailing Address - Phone:781-397-9980
Mailing Address - Fax:781-397-8811
Practice Address - Street 1:388 PLEASANT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-8143
Practice Address - Country:US
Practice Address - Phone:781-397-9980
Practice Address - Fax:781-397-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2604291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0800066Medicaid
MATR0073Medicare ID - Type Unspecified