Healthcare Provider Details

I. General information

NPI: 1639409428
Provider Name (Legal Business Name): MOUNTAIN VIEW FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 BALDWINVILLE RD
BALDWINVILLE MA
01436-1351
US

IV. Provider business mailing address

570 BALDWINVILLE RD
BALDWINVILLE MA
01436-1351
US

V. Phone/Fax

Practice location:
  • Phone: 978-939-2133
  • Fax: 978-939-8580
Mailing address:
  • Phone: 978-939-2133
  • Fax: 978-939-8580

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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN L KELLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-939-2133