Provider Demographics
NPI:1942340823
Name:R. WENDELL PIERCE M.D., P.C.
Entity Type:Organization
Organization Name:R. WENDELL PIERCE M.D., P.C.
Other - Org Name:R. W. PIERCE M.D., P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-729-9577
Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1961
Mailing Address - Country:US
Mailing Address - Phone:781-729-9577
Mailing Address - Fax:781-721-0163
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE 305
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:781-729-9577
Practice Address - Fax:781-721-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1790798361OtherDR. PIERCE'S NPI
MA0173061Medicaid
MD702532OtherTUFTS HEALTH PLAN IDENTIF
MD0239721019OtherMA BUSINESS #
MA0173061Medicaid
MA=========OtherTAX ID #
MD1790798361OtherDR. PIERCE'S NPI