MEDICARE: CIRCLE HEALTH OBGYN, LLC.

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005394	OTHER	MA	MEDICARE RAILROAD
6	0005394	OTHER	MA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1912179870	OTHER	MA	BCBS OF MA
3	1912179870	OTHER	MA	HEALTHNET OF CA
4	1912179870	OTHER	MA	HEALTHSOURCE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1912179870	OTHER	MA	CHAMPUS TRICARE
8	1912179870	OTHER	MA	PHCS
9	1912179870	OTHER	MA	UNITED HEALTH CARE
10	1912179870	OTHER	MA	CIGNA
11	1912179870	OTHER	MA	HEALTH PLANS INC
12	1912179870	OTHER	MA	NETWORK HEALTH CARE
13	1912179870	OTHER	MA	AETNA
14	1912179870	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
15	1912179870	OTHER	MA	GREAT WEST
16	1912179870	OTHER	MA	TUFTS
17	1912179870	OTHER	MA	HARVARD PILGRIM HEALTH CARE
18	1912179870	OTHER	MA	BMC HEALTH NET
19	1912179870	OTHER	MA	CHOICECARE NETWORK (HUMANA)
20	1912179870	OTHER	MA	FALLON
21	1912179870	OTHER	MA	ADVANTRA FREEDOM

General Provider Information

NPI Number	:	1912179870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE HEALTH OBGYN, LLC.

Provider Business Mailing Address
First Line	:	20 RESEARCH PL STE 320
Second Line	:
City	:	NORTH CHELMSFORD
State	:	MA
Zip	:	01863-2455
Country	:	US
Telephone Number	:	978-256-1858
Fax Number	:	978-788-7890

Provider Business Practice Location Address
First Line	:	20 RESEARCH PL STE 320
Second Line	:
City	:	NORTH CHELMSFORD
State	:	MA
Zip	:	01863-2455
Country	:	US
Telephone Number	:	978-256-1858
Fax Number	:	978-788-7890

Authorized Official
Title or Position	:	SR. VICE PRESIDENT OF FINANCE
Name	:	MR. WILLIAM F. WYMAN
Credential	:
Telephone Number	:	978-937-6034

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	11/10/2020

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