Healthcare Provider Details

I. General information

NPI: 1255487120
Provider Name (Legal Business Name): NEEDHAM FAMILY PRACTICE ASSOC. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHESTNUT ST
NEEDHAM MA
02492-2578
US

IV. Provider business mailing address

87 CHESTNUT ST P.O. BOX 920369
NEEDHAM MA
02492-2578
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-5515
  • Fax:
Mailing address:
  • Phone: 781-444-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD P. CORCORAN
Title or Position: PRESIDENT
Credential: MD
Phone: 781-444-5515