Provider Demographics
NPI:1255485058
Name:CONCORD INTERNAL MEDICINE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CONCORD INTERNAL MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:D'AMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-5575
Mailing Address - Street 1:2284 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3829
Mailing Address - Country:US
Mailing Address - Phone:978-369-5575
Mailing Address - Fax:978-371-9189
Practice Address - Street 1:2284 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3829
Practice Address - Country:US
Practice Address - Phone:978-369-5575
Practice Address - Fax:978-371-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600583OtherTUFTS HEALTH PLAN
MA9778276Medicaid
MAM15379Medicare ID - Type Unspecified
MA9778276Medicaid