Basic Information
| Provider Information | |||||||||
| NPI: | 1265493738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUDEL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015815408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088710700 | ||||||||
| FaxNumber: | 5086164411 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015815408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088710700 | ||||||||
| FaxNumber: | 5086164411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 04/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 77116 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 91114 | 01 | FALLON COMMUNITY HEALTH P | OTHER | AA1187 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J14750 | 01 | MEDICARE B | OTHER | 27004 | 01 | HEALTHY START | OTHER | 0100296 | 01 | EVERCARE | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 27004 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 4666601 | 01 | CIGNA HEALTH PLAN | OTHER | J14750 | 01 | BLUE SHIELD HMO BLUE | OTHER | 5565516 | 01 | AETNA US HEALTHCARE | OTHER | 784204 | 01 | MVP HEALTH CARE | OTHER | 934715 | 01 | FIRST HEALTH | OTHER | 3130720 | 01 | MEDICAID WELFARE | OTHER | J14750 | 01 | BLUE SHIELD INDEMNITY | OTHER | 3130720 | 05 | MA | MEDICAID | J14750 | 01 | BLUE CARE ELECT | OTHER |