Provider Demographics
NPI:1477915841
Name:GUARDIAN BROCKTON PC
Entity Type:Organization
Organization Name:GUARDIAN BROCKTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENEKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-344-2325
Mailing Address - Street 1:907 SUMNER ST # M201
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3374
Mailing Address - Country:US
Mailing Address - Phone:781-344-2325
Mailing Address - Fax:781-341-8544
Practice Address - Street 1:907 SUMNER ST # M201
Practice Address - Street 2:GUARDIAN BROCKTON PC
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3374
Practice Address - Country:US
Practice Address - Phone:781-344-2325
Practice Address - Fax:781-341-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty