Provider Demographics
NPI:1578573689
Name:PLEASANT LAKE MANAGEMENT COMPANY PC
Entity Type:Organization
Organization Name:PLEASANT LAKE MANAGEMENT COMPANY PC
Other - Org Name:PLEASANT LAKE MEDICAL OFFICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOPOLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-432-5233
Mailing Address - Street 1:253 PLEASANT LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2535
Mailing Address - Country:US
Mailing Address - Phone:508-432-5233
Mailing Address - Fax:508-430-0511
Practice Address - Street 1:253 PLEASANT LAKE AVE
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2535
Practice Address - Country:US
Practice Address - Phone:508-432-5233
Practice Address - Fax:508-430-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA670290OtherTUFTS GROUP NUMBER
MA9706470Medicaid
MAM17418OtherBCBS GROUP NUMBER
MAM20798Medicare PIN