Provider Demographics
NPI:1013031376
Name:SHREWSBURY OB/GYN, P.C.
Entity Type:Organization
Organization Name:SHREWSBURY OB/GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-842-2010
Mailing Address - Street 1:555 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2932
Mailing Address - Country:US
Mailing Address - Phone:508-842-2010
Mailing Address - Fax:508-842-8790
Practice Address - Street 1:555 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2932
Practice Address - Country:US
Practice Address - Phone:508-842-2010
Practice Address - Fax:508-842-8790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9706453Medicaid
MA2551211OtherAETNA-US HEALTHCARE HMO
MA690922OtherTUFTS HEALTH PLAN
MA53968OtherFALLON HEALTH PLAN
MASHM17724OtherBC-BS MA SHM17724
MA53968OtherFALLON HEALTH PLAN
MAM20958Medicare PIN