Provider Demographics
NPI:1003228842
Name:HAVERHILL FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:HAVERHILL FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-521-6555
Mailing Address - Street 1:62 BROWN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6778
Mailing Address - Country:US
Mailing Address - Phone:978-521-6555
Mailing Address - Fax:978-521-1236
Practice Address - Street 1:62 BROWN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6778
Practice Address - Country:US
Practice Address - Phone:978-521-6555
Practice Address - Fax:978-521-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty