Provider Demographics
NPI:1659779288
Name:COMMONWEALTH MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:COMMONWEALTH MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-249-3481
Mailing Address - Street 1:269 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6507
Mailing Address - Country:US
Mailing Address - Phone:508-485-4317
Mailing Address - Fax:
Practice Address - Street 1:126 UNION ST
Practice Address - Street 2:SUITE #1
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1207
Practice Address - Country:US
Practice Address - Phone:508-229-0239
Practice Address - Fax:508-229-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74656207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty