=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821802943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT GENERATION FAMILY PRACTICE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2025
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 PROSPECT ST
-----------------------------------------------------
City | LEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01238-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-464-1586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 PROSPECT ST
-----------------------------------------------------
City | LEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01238-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-464-1586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAMANTHA MAHER
-----------------------------------------------------
Credential | FNP-BC
-----------------------------------------------------
Telephone | 413-464-1586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------