Provider Demographics
NPI:1760600423
Name:CITY OF WOBURN
Entity Type:Organization
Organization Name:CITY OF WOBURN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AGENT WOBURN BOARD OF HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRALICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-932-4407
Mailing Address - Street 1:55 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3814
Mailing Address - Country:US
Mailing Address - Phone:781-933-8891
Mailing Address - Fax:781-937-8858
Practice Address - Street 1:55 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3814
Practice Address - Country:US
Practice Address - Phone:781-933-8891
Practice Address - Fax:781-937-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
C1Y11137Medicare ID - Type Unspecified