Healthcare Provider Details

I. General information

NPI: 1447220892
Provider Name (Legal Business Name): BICKFORD HEALTH ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MAIN ST SUITE 706A
YARMOUTH PORT MA
02675-2000
US

IV. Provider business mailing address

714 MAIN ST SUITE 706A
YARMOUTH PORT MA
02675-2000
US

V. Phone/Fax

Practice location:
  • Phone: 508-362-1600
  • Fax: 508-362-1616
Mailing address:
  • Phone: 508-362-1600
  • Fax: 508-362-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number156601
License Number StateMA

VIII. Authorized Official

Name: DR. SUSAN A HAWLEY
Title or Position: MD/PARTNER
Credential: MD
Phone: 508-362-1600