Healthcare Provider Details

I. General information

NPI: 1750309431
Provider Name (Legal Business Name): FAMILY MEDICINE ASSOCIATES OF SOUTH ATTLEBORO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 WASHINGTON ST
SOUTH ATTLEBORO MA
02703-6942
US

IV. Provider business mailing address

562 WASHINGTON ST
SOUTH ATTLEBORO MA
02703-6942
US

V. Phone/Fax

Practice location:
  • Phone: 508-761-5650
  • Fax: 508-761-9870
Mailing address:
  • Phone: 508-761-5650
  • Fax: 508-761-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MAUREEN J CABRAL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-761-5650