Provider Demographics
NPI:1649392416
Name:PRIMARY CARE NORTH PC
Entity Type:Organization
Organization Name:PRIMARY CARE NORTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:NALESNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-595-9581
Mailing Address - Street 1:225 BOSTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-3137
Mailing Address - Country:US
Mailing Address - Phone:781-595-9581
Mailing Address - Fax:781-595-9628
Practice Address - Street 1:225 BOSTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3137
Practice Address - Country:US
Practice Address - Phone:781-595-9581
Practice Address - Fax:781-595-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53680207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB1002301OtherCIGNA
MD703505OtherTUFTS
MA80744OtherFALLON
MA9705121Medicaid
MAJ04507OtherBCBS
MA9037OtherUS HEALTH
MA65494OtherHPHC
MD0400048OtherUNITED
MDB1002301OtherCIGNA
MA80744OtherFALLON