Basic Information
| Provider Information | |||||||||
| NPI: | 1538154869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY PHYSICIANS ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 S MAIN ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023684835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819866078 | ||||||||
| FaxNumber: | 7819860058 | ||||||||
| Practice Location | |||||||||
| Address1: | 92 HIGHLAND ST | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021863800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176964600 | ||||||||
| FaxNumber: | 7819860058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | OBRIEN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6173131097 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9777199 | 05 | MA | MEDICAID | M15986 | 01 | BLUE CROSS INDEMNITY | OTHER |