| Reservoir Medical Associates, P.c. | |
|
725 Concord Ave Suite 2000 Cambridge MA 02138-1040 | |
| (617) 661-4600 | |
| (617) 547-9170 |
| Full Name | Reservoir Medical Associates, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 725 Concord Ave, Cambridge, Massachusetts |
| Authorized Official Name and Position | Debra Shapiro (OWNER) |
| Authorized Official Contact | 6176614600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reservoir Medical Associates, P.c. 725 Concord Ave Suite 2000 Cambridge MA 02138-1040 Ph: (617) 661-4600 | Reservoir Medical Associates, P.c. 725 Concord Ave Suite 2000 Cambridge MA 02138-1040 Ph: (617) 661-4600 |
| NPI Number | 1356399562 |
|---|---|
| Provider Enumeration Date | 05/04/2006 |
| Last Update Date | 01/11/2013 |
| Medicare PECOS PAC ID | 9032120498 |
|---|---|
| Medicare Enrollment ID | O20060523000010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356399562 | NPI | - | NPPES |
| 9776036 | Medicaid | MA | |
| 609088 | Other | MA | TUFTS |
| M16171 | Other | MA | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 57930 (Massachusetts) | Primary |
| Provider Name | Debra S Shapiro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194775262 PECOS PAC ID: 9436196581 Enrollment ID: I20050411001152 |
| Provider Name | Kimberly Goc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518916519 PECOS PAC ID: 1658410378 Enrollment ID: I20091209000202 |
| Provider Name | Kerry O'donovan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528611514 PECOS PAC ID: 2163859927 Enrollment ID: I20200218000674 |
| Provider Name | Maryn Ashley Katz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487396016 PECOS PAC ID: 1850771890 Enrollment ID: I20220707002792 |
Google Wellness Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 355 Main St, 2nd Floor, Cambridge, MA 02142 Phone: 617-453-3005 Fax: 617-649-8535 | |
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