Basic Information
| Provider Information | |||||||||
| NPI: | 1629082177 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHELMSFORD FAMILY PRACTICE, PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 248 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018630248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782513159 | ||||||||
| FaxNumber: | 9782510636 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018631746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782513159 | ||||||||
| FaxNumber: | 9782510636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | BYRNE | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9782513159 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9786619 | 05 | MA | MEDICAID |