Healthcare Provider Details

I. General information

NPI: 1992035380
Provider Name (Legal Business Name): PRIMARY & PREVENTIVE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EAST ST
HANOVER MA
02339-1638
US

IV. Provider business mailing address

20 EAST ST
HANOVER MA
02339-1638
US

V. Phone/Fax

Practice location:
  • Phone: 781-826-3146
  • Fax: 781-826-1110
Mailing address:
  • Phone: 781-826-3146
  • Fax: 781-826-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number17300000X
License Number StateMA

VIII. Authorized Official

Name: HEATHER MEHDI
Title or Position: OFFICE
Credential:
Phone: 617-680-2442