Provider Demographics
NPI:1164811733
Name:DUTTON FAMILY CARE ASSOCIATES LLP
Entity Type:Organization
Organization Name:DUTTON FAMILY CARE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PM
Authorized Official - Phone:781-245-0402
Mailing Address - Street 1:33 AVON ST
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2310
Mailing Address - Country:US
Mailing Address - Phone:781-245-0402
Mailing Address - Fax:781-246-0847
Practice Address - Street 1:33 AVON ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2310
Practice Address - Country:US
Practice Address - Phone:781-245-0402
Practice Address - Fax:781-246-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40277207Q00000X
MA42610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB46046Medicare PIN
MAB46042Medicare PIN