Provider Demographics
NPI:1497357842
Name:PATIENT CENTERED CARE OF CAMBRIDGE
Entity Type:Organization
Organization Name:PATIENT CENTERED CARE OF CAMBRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-600-3940
Mailing Address - Street 1:3093 BEVERLY LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3433
Mailing Address - Country:US
Mailing Address - Phone:410-600-3940
Mailing Address - Fax:443-200-0266
Practice Address - Street 1:3093 BEVERLY LN UNIT A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3433
Practice Address - Country:US
Practice Address - Phone:410-600-3940
Practice Address - Fax:443-200-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty