Provider Demographics
NPI:1285761619
Name:PLYMOUTH CARVER PRIMARY CARE, P.C.
Entity type:Organization
Organization Name:PLYMOUTH CARVER PRIMARY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-746-7272
Mailing Address - Street 1:110 LONG POND RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2642
Mailing Address - Country:US
Mailing Address - Phone:508-746-7272
Mailing Address - Fax:
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:SUITE 212
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-746-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226393207Q00000X
MA47038207RC0000X
MA220157207RC0000X
MA29307207RC0000X
MA76027207RG0100X
MA182208363LA2200X
MA143121363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty