Provider Demographics
NPI:1912296633
Name:HARBOR MEDICAL ASSOCIATES P.C.
Entity type:Organization
Organization Name:HARBOR MEDICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-952-1249
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1433
Mailing Address - Fax:508-630-2462
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 414
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1433
Practice Address - Fax:508-630-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77770261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM13981Medicare PIN