Provider Demographics
NPI:1801574181
Name:ONLINE CARE GROUP PA-PC
Entity type:Organization
Organization Name:ONLINE CARE GROUP PA-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-204-3544
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:EAST ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-0020
Mailing Address - Country:US
Mailing Address - Phone:540-769-7891
Mailing Address - Fax:
Practice Address - Street 1:90 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-4043
Practice Address - Country:US
Practice Address - Phone:540-769-7891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health