Provider Demographics
NPI:1942624796
Name:PERSONAL CARE PHYSICIANS, PC
Entity Type:Organization
Organization Name:PERSONAL CARE PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-875-0328
Mailing Address - Street 1:255 LOW ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3594
Mailing Address - Country:US
Mailing Address - Phone:978-225-0378
Mailing Address - Fax:
Practice Address - Street 1:255 LOW ST
Practice Address - Street 2:SUITE 303
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3594
Practice Address - Country:US
Practice Address - Phone:978-225-0378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty