Provider Demographics
NPI:1083605984
Name:CO, JOHN PATRICK T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN PATRICK
Middle Name:T
Last Name:CO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:300 OCEAN AVENUE RCH
Practice Address - Street 2:REVERE HEALTHCARE CENTER
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-485-6024
Practice Address - Fax:781-485-6391
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-12-20
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Provider Licenses
StateLicense IDTaxonomies
MA160256208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3201325Medicaid
MAJ21625OtherBCBS MA
MA160256OtherTUFTS HEALTH PLAN
MA3201325Medicaid
G99877Medicare UPIN