Provider Demographics
NPI:1073856076
Name:WELLESLEY HILLS PCMH
Entity Type:Organization
Organization Name:WELLESLEY HILLS PCMH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:DUPEE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:781-472-0891
Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-235-9089
Mailing Address - Fax:781-237-5121
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 440
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-235-9089
Practice Address - Fax:781-237-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care