Provider Demographics
NPI:1104647817
Name:WELLSPACE PRIMARY CARE PLLC
Entity type:Organization
Organization Name:WELLSPACE PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-553-3887
Mailing Address - Street 1:10 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2111
Mailing Address - Country:US
Mailing Address - Phone:714-553-3887
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST STE 500
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2112
Practice Address - Country:US
Practice Address - Phone:781-304-8236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty