Healthcare Provider Details

I. General information

NPI: 1457302721
Provider Name (Legal Business Name): NORTH QUABBIN FAMILY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MAIN ST
ATHOL MA
01331-2102
US

IV. Provider business mailing address

201 S MAIN ST
ATHOL MA
01331-2102
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-0099
  • Fax: 978-249-7227
Mailing address:
  • Phone: 978-249-0099
  • Fax: 978-249-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY E SOULE-REGINE
Title or Position: VICE-PRESIDENT
Credential: M.D.
Phone: 978-249-0099