Provider Demographics
NPI:1982885083
Name:WESTON PRIMARY CARE, PC
Entity type:Organization
Organization Name:WESTON PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-891-0906
Mailing Address - Street 1:PO BOX 6300
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-6300
Mailing Address - Country:US
Mailing Address - Phone:401-274-0103
Mailing Address - Fax:
Practice Address - Street 1:56 COLPITTS RD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1568
Practice Address - Country:US
Practice Address - Phone:781-891-0906
Practice Address - Fax:781-891-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAG88478Medicare UPIN
MA0004409Medicare PIN