Provider Demographics
NPI:1962536607
Name:PHYSICIANS OF NORTH WORCESTER COUNTY
Entity type:Organization
Organization Name:PHYSICIANS OF NORTH WORCESTER COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:BANTING
Authorized Official - Last Name:FLAMINIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-368-3870
Mailing Address - Street 1:201 HIGHLAND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-1037
Mailing Address - Country:US
Mailing Address - Phone:978-368-3870
Mailing Address - Fax:978-368-3877
Practice Address - Street 1:80 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-3534
Practice Address - Country:US
Practice Address - Phone:978-249-7818
Practice Address - Fax:978-249-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM15501OtherBCBS
MA9768874Medicaid
MAM15501Medicare ID - Type Unspecified