Healthcare Provider Details

I. General information

NPI: 1992881437
Provider Name (Legal Business Name): TRUESDALE MEDICAL PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3411
  • Fax:
Mailing address:
  • Phone: 508-676-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14286
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1715
License Number StateMA

VIII. Authorized Official

Name: CHARLES EIL
Title or Position: PRESIDENT
Credential:
Phone: 508-676-3411