Provider Demographics
NPI:1134261365
Name:BOLTON FAMILY MEDICINE
Entity type:Organization
Organization Name:BOLTON FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-779-6262
Mailing Address - Street 1:146 HUDSON ROAD
Mailing Address - Street 2:P.O. BOX 370
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740
Mailing Address - Country:US
Mailing Address - Phone:978-779-6262
Mailing Address - Fax:978-779-6264
Practice Address - Street 1:146 HUDSON RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1444
Practice Address - Country:US
Practice Address - Phone:978-779-6262
Practice Address - Fax:978-779-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9764607Medicaid
MA9764607Medicaid