Basic Information
| Provider Information | |||||||||
| NPI: | 1003042425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST SANDWICH PHYSICIAN ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 905 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025410905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085488989 | ||||||||
| FaxNumber: | 5085485789 | ||||||||
| Practice Location | |||||||||
| Address1: | 478 ROUTE 6A | ||||||||
| Address2: | |||||||||
| City: | EAST SANDWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025371438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088331212 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2009 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | SOUZA | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING AGENCY | ||||||||
| AuthorizedOfficialTelephone: | 5085488989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 230182 | MA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | 229943 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.