MEDICARE: DR. JOHN L ETEN MD

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	207Q00000X	Family Medicine Physician	51173	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	080130572	OTHER		RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-00821	OTHER		UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	723878	OTHER		TUFTS HEALTHCARE
4	B10436901	OTHER		CIGNA HEALTHCARE
5	000000031977	OTHER		BOSTON MEDICAL HEALTHNET
6	28599	OTHER	MA	CHILDREN'S MEDICAL SECURI
7	7725	OTHER		HARVARDPILGRIM HEALTHCARE
9	J03410	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649239757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN L ETEN MD

Provider Business Mailing Address
First Line	:	204 MAIN ST
Second Line	:	ORLEANS MEDICAL CENTER, P.C.
City	:	ORLEANS
State	:	MA
Zip	:	02653-3428
Country	:	US
Telephone Number	:	508-255-8825
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 MAIN ST
Second Line	:	ORLEANS MEDICAL CENTER, P.C.
City	:	ORLEANS
State	:	MA
Zip	:	02653-3428
Country	:	US
Telephone Number	:	508-255-8825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	06/29/2010

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Directions to “ DR. JOHN L ETEN MD” Practice Location

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