Provider Demographics
NPI:1235184334
Name:EAST FALMOUTH FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:EAST FALMOUTH FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-495-0704
Mailing Address - Street 1:PO BOX 2460
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-2460
Mailing Address - Country:US
Mailing Address - Phone:508-495-0704
Mailing Address - Fax:508-495-0293
Practice Address - Street 1:331 E FALMOUTH HWY
Practice Address - Street 2:
Practice Address - City:E FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-6039
Practice Address - Country:US
Practice Address - Phone:508-495-0704
Practice Address - Fax:508-495-0293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21725Medicare ID - Type Unspecified
F64504Medicare UPIN