Provider Demographics
NPI:1023005493
Name:CORNERSTONE FAMILY PRACTICE
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAPANICOLAOU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:978-948-3902
Mailing Address - Street 1:303 C HAVERHILL ST
Mailing Address - Street 2:BOX 10
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-0010
Mailing Address - Country:US
Mailing Address - Phone:978-948-3902
Mailing Address - Fax:978-948-7530
Practice Address - Street 1:303 C HAVERHILL STREET
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-0010
Practice Address - Country:US
Practice Address - Phone:978-948-3902
Practice Address - Fax:978-948-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9721550Medicaid
MAM21179Medicare ID - Type Unspecified