Basic Information
| Provider Information | |||||||||
| NPI: | 1588706279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHELMSFORD PRIMARY CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MEETING HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782565522 | ||||||||
| FaxNumber: | 9782565399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEETING HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018242700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782565522 | ||||||||
| FaxNumber: | 9782565399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WIKANDER | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9782565522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51761 | 01 | MA | FALLON GROUP NUMBER | OTHER | 689682 | 01 | MA | TUFTS GROUP NUMBER | OTHER | 44959 | 01 | MA | NETWORK HEALTH GROUP NUMB | OTHER | 9707930 | 05 | MA | MEDICAID | CH6549 | 01 | MA | MEDICARE RR NUMBER | OTHER | M17730 | 01 | MA | BLUE CROSS GROUP NUMBER | OTHER |