1134261365 NPI number — BOLTON FAMILY MEDICINE

Table of content: (NPI 1134261365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134261365 NPI number — BOLTON FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOLTON FAMILY MEDICINE
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:
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:
1134261365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 HUDSON ROAD
Provider Second Line Business Mailing Address:
P.O. BOX 370
Provider Business Mailing Address City Name:
BOLTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-779-6262
Provider Business Mailing Address Fax Number:
978-779-6264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
146 HUDSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01740-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-779-6262
Provider Business Practice Location Address Fax Number:
978-779-6264
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FITZPATRICK
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
978-779-6262

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9764607 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com