Healthcare Provider Details

I. General information

NPI: 1407980600
Provider Name (Legal Business Name): JANET M. PRICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NORTH LAKE AVE
WORCESTER MA
01605
US

IV. Provider business mailing address

PROVIDER ENROLLMENT 100 FRONT STREET 12TH FLOOR
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-595-2855
  • Fax: 508-595-2602
Mailing address:
  • Phone: 508-368-5510
  • Fax: 508-368-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number76666
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: