Provider Demographics
NPI:1003042425
Name:EAST SANDWICH PHYSICIAN ASSOCIATES
Entity Type:Organization
Organization Name:EAST SANDWICH PHYSICIAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENCY
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-548-8989
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02541-0905
Mailing Address - Country:US
Mailing Address - Phone:508-548-8989
Mailing Address - Fax:508-548-5789
Practice Address - Street 1:478 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1438
Practice Address - Country:US
Practice Address - Phone:508-833-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229943207R00000X
MA230182207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty