Provider Demographics
| NPI: | 1902856024 |
|---|---|
| Name: | MILFORD REGIONAL PHYSICIAN GROUP, INC. |
| Entity type: | Organization |
| Organization Name: | MILFORD REGIONAL PHYSICIAN GROUP, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | PATRICK |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | MCSWEENEY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 508-473-1480 |
| Mailing Address - Street 1: | 9 INDUSTRIAL RD STE 5 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MILFORD |
| Mailing Address - State: | MA |
| Mailing Address - Zip Code: | 01757-3736 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 508-473-1480 |
| Mailing Address - Fax: | 508-473-1210 |
| Practice Address - Street 1: | 9 INDUSTRIAL RD |
| Practice Address - Street 2: | SUITE 5 |
| Practice Address - City: | MILFORD |
| Practice Address - State: | MA |
| Practice Address - Zip Code: | 01757-3735 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 508-473-1480 |
| Practice Address - Fax: | 508-473-1210 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-11 |
| Last Update Date: | 2019-09-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MA | 9768661 | Medicaid | |
| MA | M15507 | Other | BLUE CROSS BLUE SHIELD MA |