Provider Demographics
NPI:1447220892
Name:BICKFORD HEALTH ASSOCIATES, PC
Entity Type:Organization
Organization Name:BICKFORD HEALTH ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-362-1600
Mailing Address - Street 1:714 MAIN ST
Mailing Address - Street 2:SUITE 706A
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2000
Mailing Address - Country:US
Mailing Address - Phone:508-362-1600
Mailing Address - Fax:508-362-1616
Practice Address - Street 1:714 MAIN ST
Practice Address - Street 2:SUITE 706A
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2000
Practice Address - Country:US
Practice Address - Phone:508-362-1600
Practice Address - Fax:508-362-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACI3728OtherRAILROAD MEDICARE
MA9776265Medicaid
MAM16138OtherBCBS
MAM16138OtherBCBS