Healthcare Provider Details

I. General information

NPI: 1235184334
Provider Name (Legal Business Name): EAST FALMOUTH FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E FALMOUTH HWY
E FALMOUTH MA
02536-6039
US

IV. Provider business mailing address

PO BOX 2460
TEATICKET MA
02536-2460
US

V. Phone/Fax

Practice location:
  • Phone: 508-495-0704
  • Fax: 508-495-0293
Mailing address:
  • Phone: 508-495-0704
  • Fax: 508-495-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77754
License Number StateMA

VIII. Authorized Official

Name: JEANNE M MASE
Title or Position: PRESIDENT
Credential: MD
Phone: 508-495-0704