Basic Information
| Provider Information | |||||||||
| NPI: | 1194236687 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAREDOCCOMM | ||||||||
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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: | 390 ORLEANS RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHATHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026501154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089454611 | ||||||||
| FaxNumber: | 5089452245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2017 | ||||||||
| LastUpdateDate: | 10/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | BOGDANOVICH | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5089454611 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.