Healthcare Provider Details

I. General information

NPI: 1417969817
Provider Name (Legal Business Name): FAMILY CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CENTRAL ST
GEORGETOWN MA
01833-2425
US

IV. Provider business mailing address

65 CENTRAL ST
GEORGETOWN MA
01833-2425
US

V. Phone/Fax

Practice location:
  • Phone: 978-352-7780
  • Fax: 978-352-4542
Mailing address:
  • Phone: 978-352-7780
  • Fax: 978-352-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9786767
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. MARC FEDERMAN
Title or Position: PARTNER
Credential: MD
Phone: 978-352-7780