Provider Demographics
NPI:1235156241
Name:SOUTHERN NEW ENGLAND PHYSICIANS ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHERN NEW ENGLAND PHYSICIANS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L. RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-961-5930
Mailing Address - Street 1:101 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3464
Mailing Address - Country:US
Mailing Address - Phone:508-961-5930
Mailing Address - Fax:508-961-5931
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-961-5930
Practice Address - Fax:508-961-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1005690OtherNEIGHBORHOOD HEALTH PLAN
MA603203OtherTUFTS HEALTH PLAN
MAM15074OtherBCBS MA
MA000000022708OtherBMC
MA256732OtherMAGELLAN
MA9761306Medicaid
RI25369-1OtherBCBS RI
MA603203OtherTUFTS HEALTH PLAN
MAM15074Medicare ID - Type Unspecified