=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912179870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIRCLE HEALTH OBGYN, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2008
-----------------------------------------------------
Last Update Date | 11/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 RESEARCH PL STE 320
-----------------------------------------------------
City | NORTH CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01863-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-256-1858
-----------------------------------------------------
Fax | 978-788-7890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 RESEARCH PL STE 320
-----------------------------------------------------
City | NORTH CHELMSFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01863-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-256-1858
-----------------------------------------------------
Fax | 978-788-7890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. VICE PRESIDENT OF FINANCE
-----------------------------------------------------
Name | MR. WILLIAM F. WYMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-937-6034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------