Provider Demographics
NPI:1922124734
Name:TOWN OF ROCKPORT
Entity Type:Organization
Organization Name:TOWN OF ROCKPORT
Other - Org Name:ROCKPORT BOARD OF HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SYNDEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-546-3701
Mailing Address - Street 1:34 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-1537
Mailing Address - Country:US
Mailing Address - Phone:978-546-3701
Mailing Address - Fax:978-546-5013
Practice Address - Street 1:34 BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1537
Practice Address - Country:US
Practice Address - Phone:978-546-3701
Practice Address - Fax:978-546-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11086OtherPTAN/PIN