Provider Demographics
NPI:1255487120
Name:NEEDHAM FAMILY PRACTICE ASSOC. P.C.
Entity Type:Organization
Organization Name:NEEDHAM FAMILY PRACTICE ASSOC. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-444-5515
Mailing Address - Street 1:87 CHESTNUT ST
Mailing Address - Street 2:P.O. BOX 920369
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2578
Mailing Address - Country:US
Mailing Address - Phone:781-444-5515
Mailing Address - Fax:
Practice Address - Street 1:87 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2578
Practice Address - Country:US
Practice Address - Phone:781-444-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15523Medicare ID - Type UnspecifiedMEDICARE GROUP #