Provider Demographics
NPI:1386668796
Name:CERCE, BETH A (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:CERCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:152 DEAN STREET
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-824-3872
Practice Address - Fax:508-822-7975
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3188710Medicaid
MA156207OtherTAHP
MA68772OtherHPHC
MAMX2276OtherMEDICARE PTAN #
MAJ21099OtherBC/BS
MA68772OtherHPHC
MAMX2276OtherMEDICARE PTAN #