Healthcare Provider Details

I. General information

NPI: 1437157765
Provider Name (Legal Business Name): JOHN B CONSTANTINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

19 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-256-5600
  • Fax: 978-703-0250
Mailing address:
  • Phone: 978-256-5600
  • Fax: 978-703-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number71751
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number71751
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: