Provider Demographics
NPI:1710905237
Name:AUTUMN GRACE MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:AUTUMN GRACE MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-682-3939
Mailing Address - Street 1:188 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3862
Mailing Address - Country:US
Mailing Address - Phone:978-682-3939
Mailing Address - Fax:978-686-9494
Practice Address - Street 1:188 BROADWAY
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3862
Practice Address - Country:US
Practice Address - Phone:978-682-3939
Practice Address - Fax:978-686-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA080819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA91248OtherFALLON
MA9734571Medicaid
MA2609134OtherAETNA
MA625144OtherTUFTS
MA04-10314OtherUNITED HEALTHCARE
MA5667662OtherCIGNA
MA65440OtherHARVARD PILGRIM
MAM18876OtherBLUE CROSS
MAG03544Medicare UPIN
MA65440OtherHARVARD PILGRIM