MEDICARE: SHREWSBURY OB/GYN, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2551211	OTHER	MA	AETNA-US HEALTHCARE HMO
3	690922	OTHER	MA	TUFTS HEALTH PLAN
4	53968	OTHER	MA	FALLON HEALTH PLAN
5	SHM17724	OTHER	MA	BC-BS MA SHM17724

General Provider Information

NPI Number	:	1013031376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHREWSBURY OB/GYN, P.C.

Provider Business Mailing Address
First Line	:	555 MAIN STREET
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-2932
Country	:	US
Telephone Number	:	508-842-2010
Fax Number	:	508-842-8790

Provider Business Practice Location Address
First Line	:	555 MAIN STREET
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-2932
Country	:	US
Telephone Number	:	508-842-2010
Fax Number	:	508-842-8790

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BERNARD DALE MAGEE
Credential	:	MD
Telephone Number	:	508-842-2010

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/14/2011

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