Provider Demographics
NPI:1124315056
Name:FRECCERO MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:FRECCERO MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-638-2532
Mailing Address - Street 1:77 BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4201
Mailing Address - Country:US
Mailing Address - Phone:508-583-7595
Mailing Address - Fax:508-559-2278
Practice Address - Street 1:77 BYRON AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4201
Practice Address - Country:US
Practice Address - Phone:508-583-7595
Practice Address - Fax:508-559-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3191575Medicaid
MA66675OtherHARVARD PILGRIM
MAM19070OtherBLUE CROSS BLUE SHIELD
MA3078300OtherAETNA
MAJ16953OtherBCBS
MA0403406OtherUNITED HEALTH CARE
MA15454OtherTUFTS HEALTHCARE
MA0077646OtherNEIGHBORHOOD HEALTH PLAN
MA66675OtherHARVARD PILGRIM
MAM19070OtherBLUE CROSS BLUE SHIELD