Basic Information
| Provider Information | |||||||||
| NPI: | 1912179870 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CIRCLE HEALTH OBGYN, LLC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 20 RESEARCH PL STE 320 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782561858 | ||||||||
| FaxNumber: | 9787887890 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 RESEARCH PL STE 320 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782561858 | ||||||||
| FaxNumber: | 9787887890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2008 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WYMAN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9789376034 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CIRCLE HEALTH PHYSICIANS, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0005394 | 01 | MA | MEDICARE RAILROAD | OTHER | 1912179870 | 01 | MA | BCBS OF MA | OTHER | 1912179870 | 01 | MA | HEALTHNET OF CA | OTHER | 1912179870 | 01 | MA | HEALTHSOURCE | OTHER | 9737821 | 05 | MA | MEDICAID | 0005394 | 01 | MA | MEDICARE PTAN | OTHER | 1912179870 | 01 | MA | CHAMPUS TRICARE | OTHER | 1912179870 | 01 | MA | PHCS | OTHER | 1912179870 | 01 | MA | UNITED HEALTH CARE | OTHER | 1912179870 | 01 | MA | CIGNA | OTHER | 1912179870 | 01 | MA | HEALTH PLANS INC | OTHER | 1912179870 | 01 | MA | NETWORK HEALTH CARE | OTHER | 1912179870 | 01 | MA | AETNA | OTHER | 1912179870 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 1912179870 | 01 | MA | GREAT WEST | OTHER | 1912179870 | 01 | MA | TUFTS | OTHER | 1912179870 | 01 | MA | HARVARD PILGRIM HEALTH CARE | OTHER | 1912179870 | 01 | MA | BMC HEALTH NET | OTHER | 1912179870 | 01 | MA | CHOICECARE NETWORK (HUMANA) | OTHER | 1912179870 | 01 | MA | FALLON | OTHER | 1912179870 | 01 | MA | ADVANTRA FREEDOM | OTHER |