Provider Demographics
NPI:1093708927
Name:CENTRAL MASS ALLERGY & ASTHMA CARE
Entity Type:Organization
Organization Name:CENTRAL MASS ALLERGY & ASTHMA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-757-1589
Mailing Address - Street 1:100 MLK JR BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-757-1589
Mailing Address - Fax:508-756-5633
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-757-1589
Practice Address - Fax:508-756-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA57871OtherFALLON HEALTH PLAN GROUP
MA0028926OtherNEIGHBORHOOD HEALTH GROUP
MA691549OtherTUFTS HEALTH PLAN GROUP
MA9751688Medicaid
MAM17542OtherBLUE SHIELD GROUP NUMBER
MA57871OtherFALLON HEALTH PLAN GROUP
MA691549OtherTUFTS HEALTH PLAN GROUP