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General NPI Number Information
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NPI Number | 1396926630
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Entity Type | Organization
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Legal Business Name | MAVIS W. JAWORSKI, M.D.,P.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 25 HALE ST
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City | BEVERLY
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State | MA
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Zip | 01915-5268
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Country | US
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Telephone | 978-921-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CUMMINGS CTR STE 232C
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City | BEVERLY
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State | MA
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Zip | 01915-6126
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Country | US
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Telephone | 978-988-6799
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Fax | 978-998-6803
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAVIS W JAWORSKI
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Credential | M.D.
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Telephone | 978-921-5885
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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 | 151523
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License Number State | MA
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