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General NPI Number Information
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NPI Number | 1518092485
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Entity Type | Organization
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Legal Business Name | COORDINATED PRIMARY CARE DBA HEALTHALLIANCE PULMONARY
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 50 MEMORIAL DRIVE SUITE 113
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City | LEOMINSTER
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State | MA
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Zip | 01453
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Country | US
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Telephone | 978-466-2692
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Fax | 978-466-4754
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Provider Business Mailing Address
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Address Line | 50 MEMORIAL DRIVE SUITE 113
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City | LEOMINSTER
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State | MA
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Zip | 01453
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Country | US
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Telephone | 978-466-2692
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Fax | 978-466-4754
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PHYLLIS FABELLO
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Credential |
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Telephone | 978-466-4268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 216511
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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