Healthcare Provider Details

I. General information

NPI: 1003042425
Provider Name (Legal Business Name): EAST SANDWICH PHYSICIAN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 ROUTE 6A
EAST SANDWICH MA
02537-1438
US

IV. Provider business mailing address

PO BOX 905
FALMOUTH MA
02541-0905
US

V. Phone/Fax

Practice location:
  • Phone: 508-833-1212
  • Fax:
Mailing address:
  • Phone: 508-548-8989
  • Fax: 508-548-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number229943
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number230182
License Number StateMA

VIII. Authorized Official

Name: SHEILA V SOUZA
Title or Position: BILLING AGENCY
Credential:
Phone: 508-548-8989