Provider Demographics
NPI:1518938190
Name:PILGRIM MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PILGRIM MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILDER
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:781-396-1002
Mailing Address - Street 1:400 W CUMMINGS PARK
Mailing Address - Street 2:SUITE 1825
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6519
Mailing Address - Country:US
Mailing Address - Phone:781-820-9732
Mailing Address - Fax:781-989-9396
Practice Address - Street 1:400 W CUMMINGS PARK
Practice Address - Street 2:SUITE 1825
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6519
Practice Address - Country:US
Practice Address - Phone:781-820-9732
Practice Address - Fax:781-989-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39897207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600252OtherTUFTS HEALTH PLANS INC
MAM14048OtherBLUE CROSS & BLUE SHIELD
MA0012330OtherNEIGHBORHOOD HEALTH
MA9742581Medicaid
MA0012330OtherNEIGHBORHOOD HEALTH