Healthcare Provider Details

I. General information

NPI: 1518971860
Provider Name (Legal Business Name): PRIMARY PHYSICIAN PARTNERS P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 385N
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

PO BOX 2793
WORCESTER MA
01613-2793
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-7300
  • Fax: 508-363-9688
Mailing address:
  • Phone: 508-363-7300
  • Fax: 508-363-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: MS. KELLY ANN WILSON
Title or Position: BILLING MANAGER
Credential:
Phone: 508-363-7707