Basic Information
| Provider Information | |||||||||
| NPI: | 1356421945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HINGHAM WEYMOUTH FAMILY MEDICAL ASSOC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 795 BRIDGE STREET | ||||||||
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| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02191 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 795 BRIDGE STREET | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813374105 | ||||||||
| FaxNumber: | 7813376239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | ISER | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT HWFM | ||||||||
| AuthorizedOfficialTelephone: | 7813374105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 43429 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9767568 | 05 | MA | MEDICAID |