Provider Demographics
NPI:1851369599
Name:FILLIPON, NICHOLAS G (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:G
Last Name:FILLIPON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2621
Mailing Address - Country:US
Mailing Address - Phone:508-885-3025
Mailing Address - Fax:508-885-4090
Practice Address - Street 1:118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2621
Practice Address - Country:US
Practice Address - Phone:508-885-3025
Practice Address - Fax:508-885-4090
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7361575OtherAETNA US HEALTHCARE
J27867OtherBLUE CARE ELECT
J27867OtherBLUE SHIELD INDEMNITY
68422OtherHEALTHY START
0406969OtherEVERCARE
2080681OtherMEDICAID WELFARE
2219496OtherCIGNA HEALTH PLAN
A36910OtherMEDICARE B
J27867OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
MA2080681Medicaid
68422OtherCHILDRENS MEDICAL SECURIT
042472266OtherTRICARE CHAMPUS
372730OtherMVP HEALTH CARE
90534OtherFALLON COMMUNITY HEALTH P
AA3709OtherHARVARD PILGRIM HEALTH CA
042472266OtherTHREE RIVERS
I10574Medicare UPIN