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General NPI Number Information
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NPI Number | 1639409428
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 570 BALDWINVILLE RD
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City | BALDWINVILLE
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State | MA
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Zip | 01436-1351
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Country | US
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Telephone | 978-939-2133
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Fax | 978-939-8580
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Provider Business Mailing Address
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Address Line | 570 BALDWINVILLE RD
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City | BALDWINVILLE
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State | MA
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Zip | 01436-1351
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Country | US
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Telephone | 978-939-2133
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Fax | 978-939-8580
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRETCHEN L KELLEY
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Credential | M.D.
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Telephone | 978-939-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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