Healthcare Provider Details

I. General information

NPI: 1649241019
Provider Name (Legal Business Name): COORDINATED PRIMARY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BELMONT ST
WORCESTER MA
01605-2903
US

IV. Provider business mailing address

1725 MENDON RD SUITE 207
CUMBERLAND RI
02864-4337
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-6255
  • Fax:
Mailing address:
  • Phone: 401-334-2423
  • Fax: 401-334-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier9771476
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier637436
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN

VIII. Authorized Official

Name: MICHAEL COFONE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 978-466-2185