| Davis Square Family Practice | |
|
260 Elm St Suite 105 Somerville MA 02144-2951 | |
| (617) 666-9577 | |
| (617) 666-3190 |
| Full Name | Davis Square Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 260 Elm St, Somerville, Massachusetts |
| Authorized Official Name and Position | Deborah Bershel (OWNER) |
| Authorized Official Contact | 6176669577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Davis Square Family Practice 260 Elm St Suite 105 Somerville MA 02144-2951 Ph: (617) 666-9577 | Davis Square Family Practice 260 Elm St Suite 105 Somerville MA 02144-2951 Ph: (617) 666-9577 |
| NPI Number | 1780782409 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 11/10/2011 |
| Medicare PECOS PAC ID | 1355385196 |
|---|---|
| Medicare Enrollment ID | O20050614000069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780782409 | NPI | - | NPPES |
| M18036 | Other | MA | BCBS |
| 694934 | Other | MA | TUFTS HEALTH PLAN |
| 80946 | Other | MA | FALLON |
| 9722131 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Deborah Bershel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437257227 PECOS PAC ID: 8123066297 Enrollment ID: I20050419001370 |
| Provider Name | Michelle L Clarke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104187798 PECOS PAC ID: 6204084247 Enrollment ID: I20120917000136 |
| Provider Name | Carmen Leah Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013328210 PECOS PAC ID: 4981829959 Enrollment ID: I20140707001643 |
| Provider Name | Lisa J Mcgonigal |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1992250534 PECOS PAC ID: 0244506871 Enrollment ID: I20220818001982 |
| Provider Name | Andrea Dandridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760636948 PECOS PAC ID: 4183885049 Enrollment ID: I20221026000240 |
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