Provider Demographics
NPI:1760411482
Name:NAUSET FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:NAUSET FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MEINKOTH
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-240-1141
Mailing Address - Street 1:81 OLD COLONY WAY STE D
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3278
Mailing Address - Country:US
Mailing Address - Phone:508-240-1141
Mailing Address - Fax:508-240-3031
Practice Address - Street 1:81 OLD COLONY WAY STE D
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3278
Practice Address - Country:US
Practice Address - Phone:508-240-1141
Practice Address - Fax:508-240-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50504Medicare UPIN