Healthcare Provider Details

I. General information

NPI: 1093797706
Provider Name (Legal Business Name): WINCHESTER PHYSICIAN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MASSACHUSETTS AVE
ARLINGTON MA
02474-8602
US

IV. Provider business mailing address

PO BOX 760
WINCHESTER MA
01890-4260
US

V. Phone/Fax

Practice location:
  • Phone: 781-643-4507
  • Fax: 781-646-6151
Mailing address:
  • Phone: 781-756-7273
  • Fax: 781-756-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71232
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70683
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55709
License Number StateMA

VIII. Authorized Official

Name: EILEEN WILLS
Title or Position: BILLING MANAGER
Credential:
Phone: 781-756-7273