Healthcare Provider Details

I. General information

NPI: 1093708927
Provider Name (Legal Business Name): CENTRAL MASS ALLERGY & ASTHMA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MLK JR BLVD 2ND FLOOR
WORCESTER MA
01608-1209
US

IV. Provider business mailing address

100 MLK JR BLVD 2ND FLOOR
WORCESTER MA
01608-1209
US

V. Phone/Fax

Practice location:
  • Phone: 508-757-1589
  • Fax: 508-756-5633
Mailing address:
  • Phone: 508-757-1589
  • Fax: 508-756-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier57871
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON HEALTH PLAN GROUP
# 2
Identifier0028926
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNEIGHBORHOOD HEALTH GROUP
# 3
Identifier691549
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN GROUP
# 4
Identifier9751688
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 5
IdentifierM17542
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE SHIELD GROUP NUMBER

VIII. Authorized Official

Name: MRS. JOAN HAWKINS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-757-1589