Provider Demographics
NPI:1457302721
Name:NORTH QUABBIN FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:NORTH QUABBIN FAMILY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOULE-REGINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-249-0099
Mailing Address - Street 1:201 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2102
Mailing Address - Country:US
Mailing Address - Phone:978-249-0099
Mailing Address - Fax:978-249-7227
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2102
Practice Address - Country:US
Practice Address - Phone:978-249-0099
Practice Address - Fax:978-249-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9761055Medicaid
MAM15091Medicare ID - Type Unspecified