Provider Demographics
NPI:1114919313
Name:CONCORD OB/GYN ASSOCIATES PC
Entity Type:Organization
Organization Name:CONCORD OB/GYN ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDANO-ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-7627
Mailing Address - Street 1:59 ORNAC
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3317
Mailing Address - Country:US
Mailing Address - Phone:978-369-7627
Mailing Address - Fax:976-371-2240
Practice Address - Street 1:59 ORNAC
Practice Address - Street 2:SUITE 1
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3317
Practice Address - Country:US
Practice Address - Phone:978-369-7627
Practice Address - Fax:976-371-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9725733Medicaid
MAM21217Medicare ID - Type Unspecified