MEDICARE: TOWN OF DOVER

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	341600000X	Ambulance	3605	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	590011206	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	046001072	OTHER		TRICARE
2	800783	OTHER		TUFTS HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	700178	OTHER		HARVARD PILGRIM
5	033059	OTHER	MA	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1528057320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF DOVER

Provider Business Mailing Address
First Line	:	8 TURCOTTE MEMORIAL DR
Second Line	:
City	:	ROWLEY
State	:	MA
Zip	:	01969-1706
Country	:	US
Telephone Number	:	800-488-4351
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 SPRINGDALE AVE
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-2373
Country	:	US
Telephone Number	:	508-785-1130
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	DAVID TIBERI
Credential	:
Telephone Number	:	508-785-1130

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	09/27/2013

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1265441471 — MAI J. PHAN DMD
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Directions to “TOWN OF DOVER ” Practice Location

Language	Start Address	Practice Location

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