Healthcare Provider Details

I. General information

NPI: 1285761619
Provider Name (Legal Business Name): PLYMOUTH CARVER PRIMARY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONG POND RD SUITE 212
PLYMOUTH MA
02360-2642
US

IV. Provider business mailing address

110 LONG POND RD SUITE 212
PLYMOUTH MA
02360-2642
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-7272
  • Fax:
Mailing address:
  • Phone: 508-746-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number226393
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47038
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number220157
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29307
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number182208
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number143121
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number76027
License Number StateMA

VIII. Authorized Official

Name: JANICE E AIELLO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-746-7272