Provider Demographics
NPI:1013309442
Name:PHYSICIANS AT HOME
Entity Type:Organization
Organization Name:PHYSICIANS AT HOME
Other - Org Name:MD AT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-479-6620
Mailing Address - Street 1:16034 BOLT DR
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3801
Mailing Address - Country:US
Mailing Address - Phone:787-479-6620
Mailing Address - Fax:
Practice Address - Street 1:300 BLVD DE LA MONTANA
Practice Address - Street 2:APT 655
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7027
Practice Address - Country:US
Practice Address - Phone:787-479-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty