Basic Information
| Provider Information | |||||||||
| NPI: | 1023007184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEARING | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MPH, MMSC. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BROWNING | ||||||||
| OtherFirstName: | MARSHA | ||||||||
| OtherMiddleName: | FEARING | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D., MPH, MMSC. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015500040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089097799 | ||||||||
| FaxNumber: | 5087642432 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SOUTH ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015504051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087657860 | ||||||||
| FaxNumber: | 5087657861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 214020 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207SG0201X | 214020 | MA | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 207SG0202X | 214020 | MA | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Biochemical Genetics |
ID Information
| ID | Type | State | Issuer | Description | 214020 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0182931 | 05 | MA | MEDICAID | J25574 | 01 | MA | BCBS OF MA | OTHER |