Basic Information
| Provider Information | |||||||||
| NPI: | 1134134620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BURLINGTON MEDICAL GROUP,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 BOSTON RD | ||||||||
| Address2: | |||||||||
| City: | BILLERICA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018215938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815058700 | ||||||||
| FaxNumber: | 7815058775 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 BOSTON RD | ||||||||
| Address2: | |||||||||
| City: | BILLERICA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018215938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815058700 | ||||||||
| FaxNumber: | 7815058775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTHY | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7815058700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9779728 | 05 | MA | MEDICAID |