Basic Information
| Provider Information | |||||||||
| NPI: | 1861489270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BJORLIE | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 MUSSEL POINT ROAD | ||||||||
| Address2: | |||||||||
| City: | GLOUCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782815261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 HERRICK ST | ||||||||
| Address2: | LEDGEWOOD REHAB | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019151776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789223000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 49291 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2079046 | 05 | MA | MEDICAID |