Provider Demographics
NPI:1184675779
Name:DARTMOUTH MEDICAL WALK-IN PC II
Entity Type:Organization
Organization Name:DARTMOUTH MEDICAL WALK-IN PC II
Other - Org Name:FAMILY MED CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-992-5546
Mailing Address - Street 1:210 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4044
Mailing Address - Country:US
Mailing Address - Phone:508-992-5546
Mailing Address - Fax:508-990-0391
Practice Address - Street 1:210 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4044
Practice Address - Country:US
Practice Address - Phone:508-992-5546
Practice Address - Fax:508-990-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9757627Medicaid
MAM14196Medicare ID - Type Unspecified