Basic Information
| Provider Information | |||||||||
| NPI: | 1902976558 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINCHESTER PHYSICIAN ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 760 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018904260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817567273 | ||||||||
| FaxNumber: | 7817567274 | ||||||||
| Practice Location | |||||||||
| Address1: | 88 MONTVALE AVE | ||||||||
| Address2: | STE 1 | ||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021803643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812794064 | ||||||||
| FaxNumber: | 7812793946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | WILLS | ||||||||
| AuthorizedOfficialFirstName: | EILEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7817567273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 37063 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 35266 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 204890 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 9777229 | 05 | MA | MEDICAID |