Healthcare Provider Details

I. General information

NPI: 1942405782
Provider Name (Legal Business Name): PERSONAL PHYSICIANS HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WORCESTER STREET SUITE 301
WELLESLEY MA
02481
US

IV. Provider business mailing address

1244 BOYLSTON ST SUITE 306
CHESTNUT HILL MA
02467-2116
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-0058
  • Fax: 617-731-0825
Mailing address:
  • Phone: 617-731-0058
  • Fax: 617-731-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE K PIVOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-731-0058