Provider Demographics
NPI: | 1902856024 |
---|---|
Name: | MILFORD REGIONAL PHYSICIAN GROUP, INC. |
Entity type: | Organization |
Organization Name: | MILFORD REGIONAL PHYSICIAN GROUP, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PATRICK |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | MCSWEENEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 508-473-1480 |
Mailing Address - Street 1: | 9 INDUSTRIAL RD STE 5 |
Mailing Address - Street 2: | |
Mailing Address - City: | MILFORD |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01757-3736 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-473-1480 |
Mailing Address - Fax: | 508-473-1210 |
Practice Address - Street 1: | 9 INDUSTRIAL RD |
Practice Address - Street 2: | SUITE 5 |
Practice Address - City: | MILFORD |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01757-3735 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-473-1480 |
Practice Address - Fax: | 508-473-1210 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-11 |
Last Update Date: | 2019-09-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 9768661 | Medicaid | |
MA | M15507 | Other | BLUE CROSS BLUE SHIELD MA |