Basic Information
| Provider Information | |||||||||
| NPI: | 1003002312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPKINS | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 500 CONGRESS ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021690917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177739198 | ||||||||
| FaxNumber: | 6717699952 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 CONGRESS ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021690917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177739198 | ||||||||
| FaxNumber: | 6717699952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 10/01/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 49846 | MA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | R01119 | 01 | MA | MDICARE | OTHER | 3007391 | 05 | MA | MEDICAID |