Healthcare Provider Details

I. General information

NPI: 1215919931
Provider Name (Legal Business Name): WINCHESTER PHYSICIAN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MAIN ST
NORTH READING MA
01864-3103
US

IV. Provider business mailing address

PO BOX 760
WINCHESTER MA
01890-4260
US

V. Phone/Fax

Practice location:
  • Phone: 978-664-1990
  • Fax: 978-664-5028
Mailing address:
  • Phone: 781-756-7273
  • Fax: 781-756-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47892
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81873
License Number StateMA

VIII. Authorized Official

Name: EILEEN WILLS
Title or Position: BILLING MANAGER
Credential:
Phone: 781-756-7273