Healthcare Provider Details

I. General information

NPI: 1356573349
Provider Name (Legal Business Name): NORTHSTAR MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WILLARD ST SUITE 103
QUINCY MA
02169-1252
US

IV. Provider business mailing address

40 WILLARD ST SUITE 103
QUINCY MA
02169-1252
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-0011
  • Fax: 617-481-1284
Mailing address:
  • Phone: 617-471-0011
  • Fax: 617-481-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number215383
License Number StateMA

VIII. Authorized Official

Name: DR. NASIR ALAM BHATTI
Title or Position: MANAGER/MEMBER
Credential: MD
Phone: 857-247-8538