Provider Demographics
NPI:1801860200
Name:MCBRINE & VASCONCELLOS MD PC
Entity Type:Organization
Organization Name:MCBRINE & VASCONCELLOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VASCONCELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-339-2105
Mailing Address - Street 1:205 CHAUNCY ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1202
Mailing Address - Country:US
Mailing Address - Phone:508-339-2105
Mailing Address - Fax:508-339-5837
Practice Address - Street 1:205 CHAUNCEY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048
Practice Address - Country:US
Practice Address - Phone:508-339-2105
Practice Address - Fax:508-339-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9777954Medicaid
MA9777954Medicaid