Healthcare Provider Details

I. General information

NPI: 1508164583
Provider Name (Legal Business Name): WACHUSETT EMERGENCY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NICHOLS RD BURBANK URGENT CARE CENTER
FITCHBURG MA
01420-1919
US

IV. Provider business mailing address

60 HOSPITAL RD
LEOMINSTER MA
01453-2205
US

V. Phone/Fax

Practice location:
  • Phone: 978-343-5074
  • Fax: 978-343-5418
Mailing address:
  • Phone: 978-466-2994
  • Fax: 978-466-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BONNIE RYAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-466-2428