Basic Information
| Provider Information | |||||||||
| NPI: | 1356394902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREAT WORKS FAMILY PRACTICE, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 PORTLAND ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | SOUTH BERWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039081203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073849212 | ||||||||
| FaxNumber: | 2073842008 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 PORTLAND ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | SOUTH BERWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039081203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073849212 | ||||||||
| FaxNumber: | 2073842008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | YARIAN | ||||||||
| AuthorizedOfficialFirstName: | FIA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2073849212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.