Provider Demographics
NPI:1093983769
Name:TOWN OF MIDDLETON
Entity Type:Organization
Organization Name:TOWN OF MIDDLETON
Other - Org Name:BOARD OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLERTON
Authorized Official - Suffix:
Authorized Official - Credentials:RS CHO
Authorized Official - Phone:978-777-1869
Mailing Address - Street 1:195 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949
Mailing Address - Country:US
Mailing Address - Phone:978-777-1869
Mailing Address - Fax:978-774-0718
Practice Address - Street 1:195 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949
Practice Address - Country:US
Practice Address - Phone:978-777-1869
Practice Address - Fax:978-774-0718
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF MIDDLETON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11028Medicare PIN