Basic Information
| Provider Information | |||||||||
| NPI: | 1588638431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLATT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 BROTHERTON WAY | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015012684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087211170 | ||||||||
| FaxNumber: | 5088320859 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 SOUTHBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015012498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087211172 | ||||||||
| FaxNumber: | 5088320859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 50706 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 27113 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 784175 | 01 | MVP HEALTH CARE | OTHER | 9900153 | 01 | FALLON COMMUNITY HEALTH P | OTHER | J02589 | 01 | BLUE CARE ELECT | OTHER | J02589 | 01 | BLUE SHIELD HMO BLUE | OTHER | 7387317 | 01 | AETNA US HEALTHCARE | OTHER | 0401693 | 01 | EVERCARE | OTHER | 3087689 | 05 | MA | MEDICAID | AA1242 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J02589 | 01 | MEDICARE B | OTHER | 2411249 | 01 | CIGNA HEALTH PLAN | OTHER | 27113 | 01 | HEALTHY START | OTHER | J02589 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 918144 | 01 | FIRST HEALTH | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 3087689 | 01 | MEDICAID WELFARE | OTHER |