1053696286 NPI number — NEW BEDFORD MEDICAL ASSOCIATES,PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053696286 NPI number — NEW BEDFORD MEDICAL ASSOCIATES,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BEDFORD MEDICAL ASSOCIATES,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053696286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MILL RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FAIRHAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02719-5252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-985-5020
Provider Business Mailing Address Fax Number:
508-985-5036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 FAUNCE CORNER RD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
N DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-1271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-990-1408
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MELLO
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-999-5666

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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