Provider Demographics
NPI:1902363294
Name:PRIMARY CARE PHYSICIAN NORTH PC
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIAN NORTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-308-8276
Mailing Address - Street 1:6 ESSEX CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2906
Mailing Address - Country:US
Mailing Address - Phone:978-558-4050
Mailing Address - Fax:978-871-2792
Practice Address - Street 1:6 ESSEX CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2906
Practice Address - Country:US
Practice Address - Phone:978-558-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty