Provider Demographics
NPI:1316784457
Name:CORE CARE CLINIC LLC
Entity type:Organization
Organization Name:CORE CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LINGISETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-817-1428
Mailing Address - Street 1:144 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-4837
Mailing Address - Country:US
Mailing Address - Phone:501-817-1428
Mailing Address - Fax:
Practice Address - Street 1:144 CRICKET LN
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-4837
Practice Address - Country:US
Practice Address - Phone:501-817-1428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty