Provider Demographics
NPI:1063820413
Name:INTEGRATIVE FAMILY MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:INTEGRATIVE FAMILY MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-635-1800
Mailing Address - Street 1:529 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3965
Mailing Address - Country:US
Mailing Address - Phone:978-635-1800
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3934
Practice Address - Country:US
Practice Address - Phone:978-635-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty