Provider Demographics
NPI:1558403949
Name:WOMENS HEALTH CARE OF NEW ENGLAND
Entity Type:Organization
Organization Name:WOMENS HEALTH CARE OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:781-662-7385
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:#118
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-662-7385
Mailing Address - Fax:781-662-7526
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:#118
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-662-7385
Practice Address - Fax:781-662-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48679207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B73138Medicare UPIN
MAB40079Medicare ID - Type Unspecified