Provider Demographics
NPI:1811920531
Name:CROWN OBSTETRICS & GYNECOLOGY P.C.
Entity type:Organization
Organization Name:CROWN OBSTETRICS & GYNECOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-479-6636
Mailing Address - Street 1:300 CONGRESS STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-479-6636
Mailing Address - Fax:617-472-9868
Practice Address - Street 1:300 CONGRESS ST STE 102
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0907
Practice Address - Country:US
Practice Address - Phone:617-479-6636
Practice Address - Fax:617-472-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781455Medicaid
MA9781455Medicaid