Healthcare Provider Details

I. General information

NPI: 1124554357
Provider Name (Legal Business Name): WINCHESTER PHYSICIAN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MAIN STREET SUITE 1
WINCHESTER MA
01890
US

IV. Provider business mailing address

1021 MAIN STREET SUITE 1
WINCHESTER MA
01890
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-1021
  • Fax: 781-729-7504
Mailing address:
  • Phone: 781-729-1021
  • Fax: 781-729-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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