Healthcare Provider Details

I. General information

NPI: 1447365408
Provider Name (Legal Business Name): ACTON MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST
ACTON MA
01720-3718
US

IV. Provider business mailing address

321 MAIN ST
ACTON MA
01720-3718
US

V. Phone/Fax

Practice location:
  • Phone: 978-635-8801
  • Fax: 978-635-8920
Mailing address:
  • Phone: 978-635-8801
  • Fax: 978-635-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110071215A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
IdentifierM14933
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMEDICARE

VIII. Authorized Official

Name: CHRISTINA M RUSSELL
Title or Position: HR MANAGER & CREDENTALIER
Credential:
Phone: 978-635-8805