Provider Demographics
NPI:1073968772
Name:HOME PHYSICIAN PC
Entity Type:Organization
Organization Name:HOME PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-837-1118
Mailing Address - Street 1:274 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-5828
Mailing Address - Country:US
Mailing Address - Phone:781-837-1118
Mailing Address - Fax:
Practice Address - Street 1:274 SPRING ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-5828
Practice Address - Country:US
Practice Address - Phone:781-837-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-01
Last Update Date:2016-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210184251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932147444Medicare PIN