Provider Demographics
NPI:1518914134
Name:CHOICES INTEGRATIVE AND PREVENTIVE FAMILY PRACTICE
Entity Type:Organization
Organization Name:CHOICES INTEGRATIVE AND PREVENTIVE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-463-0001
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:WEST PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7190
Mailing Address - Country:US
Mailing Address - Phone:781-231-7026
Mailing Address - Fax:
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:774-463-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
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
MA714677OtherHARVARD PILGRIM HELATH CA
MAM18261OtherBLUE CROSS/BLUE SHIELD
MA9725211Medicaid
MAM18261OtherBLUE CROSS/BLUE SHIELD