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NPI Code Detail

MEDICARE: WILLOW STREET FAMILY PRACTICE INC

MEDICARE: WILLOW STREET FAMILY PRACTICE INC
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
1207Q00000XFamily Medicine Physician70411MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M18879OTHERMABCBS GROUP PROVIDER NUMBE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619034410
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOW STREET FAMILY PRACTICE INC
Provider Business Mailing Address
First Line : 42 ASBURY ST
Second Line :
City : SOUTH HAMILTON
State : MA
Zip : 01982-1808
Country : US
Telephone Number : 978-468-4101
Fax Number :
Provider Business Practice Location Address
First Line : 42 ASBURY ST
Second Line :
City : SOUTH HAMILTON
State : MA
Zip : 01982-1808
Country : US
Telephone Number : 978-468-4101
Fax Number :
Authorized Official
Title or Position : OWNER
Name : BRUCE W SMITH
Credential : M.D.
Telephone Number : 978-468-4101
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/29/2015

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Directions to “WILLOW STREET FAMILY PRACTICE INC ” Practice Location

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