Provider Demographics
NPI:1720142912
Name:READING FAMILY MEDICINE PC
Entity type:Organization
Organization Name:READING FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:JEVON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-942-0380
Mailing Address - Street 1:30 NEWCROSSING RD STE 301
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3254
Mailing Address - Country:US
Mailing Address - Phone:781-942-0380
Mailing Address - Fax:781-246-6725
Practice Address - Street 1:30 NEWCROSSING RD STE 301
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3254
Practice Address - Country:US
Practice Address - Phone:781-942-0380
Practice Address - Fax:781-246-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA058057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1104898022OtherINDIVIDUAL NPI