Healthcare Provider Details

I. General information

NPI: 1063820413
Provider Name (Legal Business Name): INTEGRATIVE FAMILY MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST STE B
ACTON MA
01720-3934
US

IV. Provider business mailing address

529 MAIN ST STE B
ACTON MA
01720-3965
US

V. Phone/Fax

Practice location:
  • Phone: 978-635-1800
  • Fax:
Mailing address:
  • Phone: 978-635-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KAVITHA GAZULA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 978-635-1800