Provider Demographics
NPI:1417723263
Name:COMMONWEALTH PRIMARY CARE INC.
Entity Type:Organization
Organization Name:COMMONWEALTH PRIMARY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-846-5352
Mailing Address - Street 1:365 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1637
Mailing Address - Country:US
Mailing Address - Phone:617-846-5352
Mailing Address - Fax:
Practice Address - Street 1:365 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1637
Practice Address - Country:US
Practice Address - Phone:617-846-5352
Practice Address - Fax:617-846-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care