Provider Demographics
NPI:1376709683
Name:INTERNAL MEDICINE AND ENDOCRINOLOGY, INC.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND ENDOCRINOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-754-8000
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1953
Mailing Address - Country:US
Mailing Address - Phone:508-754-8000
Mailing Address - Fax:508-752-8286
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-754-8000
Practice Address - Fax:508-752-8286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35925261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2055643Medicaid
D94186Medicare UPIN
N01728Medicare PIN