{
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"OrgName": "DORCHESTER FAMILY MEDICINE, LLC",
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"FirstLineMailingAddress": "1518 GARY CREEK RD",
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"MailingAddressCityName": "CAMBRIDGE",
"MailingAddressStateName": "MD",
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"FirstLinePracticeLocationAddress": "300 DORCHESTER AVE",
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"EnumerationDate": "07/25/2018",
"LastUpdateDate": "07/25/2018",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "COULBOURN",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "D0080826",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}