Healthcare Provider Details

I. General information

NPI: 1457999351
Provider Name (Legal Business Name): ORTHOPEDIC CARE PHYSICIAN NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FORBES BLVD STE 1000
MANSFIELD MA
02048-1281
US

IV. Provider business mailing address

15 ROCHE BROTHERS WAY STE 200
NORTH EASTON MA
02356-1000
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-3535
  • Fax: 781-341-2404
Mailing address:
  • Phone: 781-573-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA DECOUTO
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 508-496-5537