Basic Information
| Provider Information | |||||||||
| NPI: | 1639386204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARITAS PHYSICIAN NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 SADDLE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020301618 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1428 MAIN ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020811729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086684007 | ||||||||
| FaxNumber: | 5086685769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUGGAN | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5086684007 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 176613 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0020774 | 01 | MA | NHP | OTHER | NP2013 | 01 | MA | BCBS INDEMNITY | OTHER | 0343820 | 05 | MA | MEDICAID | NP2013 | 01 | MA | BLUE CARE 65 | OTHER | 0343820 | 01 | MA | HEALTHY START | OTHER |