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General NPI Number Information
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NPI Number | 1013346188
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Entity Type | Organization
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Legal Business Name | MOUNT GRACE FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 119 NEW ATHOL RD
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City | ORANGE
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State | MA
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Zip | 01364-9603
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Country | US
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Telephone | 978-249-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 51 WHEELER RD
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City | WARWICK
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State | MA
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Zip | 01378-9345
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Country | US
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Telephone | 617-835-2422
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EKATERINA BRODSKI-QUIGLEY
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Credential | M.D.
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Telephone | 978-249-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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