Basic Information
| Provider Information | |||||||||
| NPI: | 1841252327 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEMC EMERGENCY ASSOC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 LAKEVILLE BUSINESS PARK | ||||||||
| Address2: | |||||||||
| City: | LAKEVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089477558 | ||||||||
| FaxNumber: | 5089461494 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176364720 | ||||||||
| FaxNumber: | 6176364723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARNEWOLT | ||||||||
| AuthorizedOfficialFirstName: | BRIEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6176364720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9779051 | 05 | MA | MEDICAID |