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General NPI Number Information
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NPI Number | 1336458439
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Entity Type | Organization
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Legal Business Name | BEACON PRIMARY MEDICINE
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 1755 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-5349
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Country | US
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Telephone | 617-794-1463
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-5349
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Country | US
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Telephone | 617-794-1463
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBIN STANTON MAYFIELD
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Credential | M.D.
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Telephone | 617-794-1463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 78250
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License Number State | MA
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