Provider Demographics
NPI:1790952695
Name:LYNN FILLIPON, NICOLE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:LYNN FILLIPON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:508-764-2432
Practice Address - Street 1:79 SAYLES ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-1729
Practice Address - Country:US
Practice Address - Phone:508-764-6041
Practice Address - Fax:508-764-6318
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA243404207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease