Provider Demographics
NPI:1912179870
Name:CIRCLE HEALTH OBGYN, LLC.
Entity Type:Organization
Organization Name:CIRCLE HEALTH OBGYN, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-937-6034
Mailing Address - Street 1:20 RESEARCH PL STE 320
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2455
Mailing Address - Country:US
Mailing Address - Phone:978-256-1858
Mailing Address - Fax:978-788-7890
Practice Address - Street 1:20 RESEARCH PL STE 320
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2455
Practice Address - Country:US
Practice Address - Phone:978-256-1858
Practice Address - Fax:978-788-7890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIRCLE HEALTH PHYSICIANS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005394OtherMEDICARE RAILROAD
MA1912179870OtherBCBS OF MA
MA1912179870OtherHEALTHNET OF CA
MA1912179870OtherHEALTHSOURCE
MA9737821Medicaid
MA0005394OtherMEDICARE PTAN
MA1912179870OtherCHAMPUS TRICARE
MA1912179870OtherPHCS
MA1912179870OtherUNITED HEALTH CARE
MA1912179870OtherCIGNA
MA1912179870OtherHEALTH PLANS INC
MA1912179870OtherNETWORK HEALTH CARE
MA1912179870OtherAETNA
MA1912179870OtherNEIGHBORHOOD HEALTH PLAN
MA1912179870OtherGREAT WEST
MA1912179870OtherTUFTS
MA1912179870OtherHARVARD PILGRIM HEALTH CARE
MA1912179870OtherBMC HEALTH NET
MA1912179870OtherCHOICECARE NETWORK (HUMANA)
MA1912179870OtherFALLON
MA1912179870OtherADVANTRA FREEDOM