| Revere Medical Of Massachusetts, Pc | |
|
1 Pearl St Ste 2100 Brockton MA 02301-2868 | |
| (508) 897-6040 | |
| Not Available |
| Full Name | Revere Medical Of Massachusetts, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1 Pearl St Ste 2100, Brockton, Massachusetts |
| Authorized Official Name and Position | Jane Holden (BILLING MANAGER) |
| Authorized Official Contact | 6156727122 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revere Medical Of Massachusetts, Pc 40 Burton Hills Blvd Ste 370 Nashville TN 37215-6287 Ph: (615) 672-7122 | Revere Medical Of Massachusetts, Pc 1 Pearl St Ste 2100 Brockton MA 02301-2868 Ph: (508) 897-6040 |
| NPI Number | 1336976539 |
|---|---|
| Provider Enumeration Date | 09/19/2024 |
| Last Update Date | 06/14/2025 |
| Medicare PECOS PAC ID | 0749715795 |
|---|---|
| Medicare Enrollment ID | O20241127001349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336976539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jorge Andrade |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942261490 PECOS PAC ID: 3870497092 Enrollment ID: I20031120000438 |
| Provider Name | Jonathan K Gordon |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1568460483 PECOS PAC ID: 3577465491 Enrollment ID: I20040122000235 |
| Provider Name | Shahab Mohiuddin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447225834 PECOS PAC ID: 8123920824 Enrollment ID: I20040123000002 |
| Provider Name | Arvind K Agnihotri |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1528058625 PECOS PAC ID: 3779478417 Enrollment ID: I20040220000210 |
| Provider Name | Stanley K Tam |
|---|---|
| Provider Type | Practitioner - Cardiac Surgery |
| Provider Identifiers | NPI Number: 1942291570 PECOS PAC ID: 8123913746 Enrollment ID: I20040220000807 |
| Provider Name | Paul A Ruggieri |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1225065113 PECOS PAC ID: 4688563992 Enrollment ID: I20040315000114 |
| Provider Name | Nicole J Pecquex |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1467447300 PECOS PAC ID: 8527050871 Enrollment ID: I20040330000889 |
| Provider Name | Brian E Dalton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609840396 PECOS PAC ID: 3779577218 Enrollment ID: I20040408001196 |
| Provider Name | Larry E Chin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760476832 PECOS PAC ID: 2567444086 Enrollment ID: I20040607000961 |
| Provider Name | Peter Rees |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104814870 PECOS PAC ID: 8325020209 Enrollment ID: I20040608000204 |
| Provider Name | Liam J Hurley |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1093765992 PECOS PAC ID: 4082699400 Enrollment ID: I20040621001086 |
| Provider Name | Peter Augustinos |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1518936327 PECOS PAC ID: 6103897541 Enrollment ID: I20040802000321 |
| Provider Name | Joseph August |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902802879 PECOS PAC ID: 4486625837 Enrollment ID: I20040802000402 |
| Provider Name | Brett Sheridan Stecker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114097599 PECOS PAC ID: 5991776379 Enrollment ID: I20040802000632 |
| Provider Name | James R Hill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215923735 PECOS PAC ID: 2062484462 Enrollment ID: I20040806000839 |
| Provider Name | Vaidyanathapuram S Balakrishnan |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1326095548 PECOS PAC ID: 8628040300 Enrollment ID: I20040812000287 |
| Provider Name | Jerald Katz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1568479046 PECOS PAC ID: 5193798445 Enrollment ID: I20040816001004 |
| Provider Name | Alice M Comerford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245240068 PECOS PAC ID: 3779552161 Enrollment ID: I20041001000652 |
| Provider Name | Michael V Orlov |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1407844020 PECOS PAC ID: 1658337092 Enrollment ID: I20041207000765 |
| Provider Name | Howard A Fogel |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1578618906 PECOS PAC ID: 7113984998 Enrollment ID: I20041214000032 |
| Provider Name | Christian Campos |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1235238882 PECOS PAC ID: 0446218697 Enrollment ID: I20041221000065 |
| Provider Name | Irene A Belsky |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114995982 PECOS PAC ID: 1658323266 Enrollment ID: I20050211000253 |
| Provider Name | Faisal S Hamada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851387799 PECOS PAC ID: 5890740575 Enrollment ID: I20050315000912 |
| Provider Name | Winny Ou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023003274 PECOS PAC ID: 0244286235 Enrollment ID: I20050323000332 |
| Provider Name | Vincent E Paquette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851385389 PECOS PAC ID: 5294781233 Enrollment ID: I20050323000682 |
| Provider Name | Joseph P Kagan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851388029 PECOS PAC ID: 0648226357 Enrollment ID: I20050325000240 |
| Provider Name | Joseph M Weinstein |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1558346031 PECOS PAC ID: 0547216251 Enrollment ID: I20050325000249 |
| Provider Name | Gary L Miller |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1942390208 PECOS PAC ID: 3072569623 Enrollment ID: I20050325000665 |
| Provider Name | James M Macek |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033193750 PECOS PAC ID: 5193784247 Enrollment ID: I20050331000402 |
| Provider Name | Anthony E Turiano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821084757 PECOS PAC ID: 0941257018 Enrollment ID: I20050401000070 |
| Provider Name | Bruce J Kriegel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376562447 PECOS PAC ID: 6406803048 Enrollment ID: I20050405001217 |
| Provider Name | Brian W Blanchette |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821071861 PECOS PAC ID: 4486691581 Enrollment ID: I20050411000730 |
| Provider Name | David W Mudd |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750376794 PECOS PAC ID: 5890732523 Enrollment ID: I20050413000934 |
| Provider Name | Alexander Pang |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1497898316 PECOS PAC ID: 0547207276 Enrollment ID: I20050413001006 |
| Provider Name | Besher Jazmati |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255430575 PECOS PAC ID: 1850338500 Enrollment ID: I20050413001162 |
| Provider Name | Neal Friedman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194712257 PECOS PAC ID: 8426096751 Enrollment ID: I20050419000031 |
| Provider Name | Margaret Mary Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992792055 PECOS PAC ID: 6305884024 Enrollment ID: I20050421001410 |
| Provider Name | Peter P Lacamera |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1124061759 PECOS PAC ID: 7911946371 Enrollment ID: I20050426001030 |
| Provider Name | John W Kinch |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1093797425 PECOS PAC ID: 1254371883 Enrollment ID: I20050503001121 |
| Provider Name | Lucy A Bayer-zwirello |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1376538355 PECOS PAC ID: 8527008168 Enrollment ID: I20050503001218 |
| Provider Name | Michele A Eldredge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215971460 PECOS PAC ID: 9335182286 Enrollment ID: I20050602000423 |
| Provider Name | Henry J Merola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902963986 PECOS PAC ID: 9234172016 Enrollment ID: I20050602000645 |
| Provider Name | Edward C Dow |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1437131000 PECOS PAC ID: 6002859212 Enrollment ID: I20050608000953 |
| Provider Name | Mawya Shocair |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1457308140 PECOS PAC ID: 5395780340 Enrollment ID: I20050621000888 |
| Provider Name | Cynthia A Arrasin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275523185 PECOS PAC ID: 4385689777 Enrollment ID: I20050627000337 |
| Provider Name | Ann M Sabatino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902816911 PECOS PAC ID: 1456397637 Enrollment ID: I20050629000128 |
| Provider Name | Andrew L Kriegel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588680854 PECOS PAC ID: 4082640750 Enrollment ID: I20050714000531 |
| Provider Name | Benoy J Zachariah |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1457376717 PECOS PAC ID: 5890721567 Enrollment ID: I20050714000553 |
| Provider Name | Caroline B Mudd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134100241 PECOS PAC ID: 2961430368 Enrollment ID: I20050727000857 |
| Provider Name | Kaarkuzhali Krishnamurthy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649227356 PECOS PAC ID: 4880622786 Enrollment ID: I20050802000213 |
| Provider Name | Diana Rodriguez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1508849811 PECOS PAC ID: 4981633518 Enrollment ID: I20050804000452 |
| Provider Name | James D Popkin |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1477550408 PECOS PAC ID: 5698706968 Enrollment ID: I20050826000010 |
| Provider Name | Elisa A.f Mulcahy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952397176 PECOS PAC ID: 1759314347 Enrollment ID: I20050914000675 |
| Provider Name | Philip S Weinstein |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1205833282 PECOS PAC ID: 1355327388 Enrollment ID: I20050923000226 |
| Provider Name | James P Morgan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1255312385 PECOS PAC ID: 5991730475 Enrollment ID: I20051004000319 |
| Provider Name | Marcy Gleit Carty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326038928 PECOS PAC ID: 6103844725 Enrollment ID: I20051102000769 |
| Provider Name | Mandy Kaur |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730116328 PECOS PAC ID: 6608894852 Enrollment ID: I20051105000222 |
| Provider Name | Katherine S Pacheco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821025719 PECOS PAC ID: 4385663574 Enrollment ID: I20051116000961 |
| Provider Name | Susan E Gipson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841370962 PECOS PAC ID: 2163442492 Enrollment ID: I20051201000710 |
| Provider Name | Catherine Tucker |
|---|---|
| Provider Type | Practitioner - Surgical Oncology |
| Provider Identifiers | NPI Number: 1730130832 PECOS PAC ID: 1951322841 Enrollment ID: I20051207000439 |
| Provider Name | Sheryl M Barkan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760448971 PECOS PAC ID: 7012938954 Enrollment ID: I20051207000794 |
| Provider Name | James Hermenegildo |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184651176 PECOS PAC ID: 7214959105 Enrollment ID: I20051220000352 |
| Provider Name | Sharda Kaul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427068097 PECOS PAC ID: 9234172552 Enrollment ID: I20060113000283 |
| Provider Name | Jan M Hutton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336164870 PECOS PAC ID: 2961426226 Enrollment ID: I20060125000713 |
| Provider Name | Christine Hatch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831304138 PECOS PAC ID: 5294749107 Enrollment ID: I20060131000279 |
| Provider Name | Joanne M Swenson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306818372 PECOS PAC ID: 4284649559 Enrollment ID: I20060208000630 |
| Provider Name | Judith Smith Casey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699754861 PECOS PAC ID: 8921014366 Enrollment ID: I20060222000732 |
| Provider Name | Ann Glasman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699883736 PECOS PAC ID: 6901813690 Enrollment ID: I20060322000060 |
| Provider Name | Michael Johnstone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235164336 PECOS PAC ID: 5395753032 Enrollment ID: I20060322000546 |
| Provider Name | Malgorzata E Cywinska |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497771091 PECOS PAC ID: 6305855081 Enrollment ID: I20060406000686 |
| Provider Name | Jean-pierre Michel Geagea |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1104884022 PECOS PAC ID: 7719885763 Enrollment ID: I20060419000552 |
| Provider Name | Sanjay Basu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285682450 PECOS PAC ID: 6002872454 Enrollment ID: I20060608000102 |
| Provider Name | Jonathan C Cluett |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1083650824 PECOS PAC ID: 3072530369 Enrollment ID: I20060819000021 |
| Provider Name | Marta Onyskiv |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619081510 PECOS PAC ID: 9335143163 Enrollment ID: I20060908000146 |
| Provider Name | Uma Kolli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972545341 PECOS PAC ID: 9032115217 Enrollment ID: I20061011000344 |
| Provider Name | Nawar Najjar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265445068 PECOS PAC ID: 0143226019 Enrollment ID: I20061017000272 |
| Provider Name | Jack M Kirichian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538258199 PECOS PAC ID: 4789682592 Enrollment ID: I20061109000570 |
| Provider Name | John V Wylie |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1720030026 PECOS PAC ID: 5799785416 Enrollment ID: I20070103000312 |
| Provider Name | Irma E Rasmussen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144287236 PECOS PAC ID: 1951295880 Enrollment ID: I20070613000395 |
| Provider Name | Montu Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295803534 PECOS PAC ID: 2466553441 Enrollment ID: I20070720000220 |
| Provider Name | Thanh Nguyen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1922162221 PECOS PAC ID: 4183725179 Enrollment ID: I20070720000236 |
| Provider Name | Raquel F Volney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679663199 PECOS PAC ID: 6406882117 Enrollment ID: I20070727000052 |
| Provider Name | Guido A Navarra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265489058 PECOS PAC ID: 2062443906 Enrollment ID: I20070731000430 |
| Provider Name | Rosalind Rabin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205990306 PECOS PAC ID: 4789772443 Enrollment ID: I20071113000498 |
| Provider Name | Nicholas M Tsanotelis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114900057 PECOS PAC ID: 2365531316 Enrollment ID: I20071129000106 |
| Provider Name | Matthew D Rosen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1992780571 PECOS PAC ID: 3971685314 Enrollment ID: I20080124000445 |
| Provider Name | Judith G King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467437947 PECOS PAC ID: 2668554577 Enrollment ID: I20080131000265 |
| Provider Name | Monica E Chavez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669535340 PECOS PAC ID: 0446297659 Enrollment ID: I20080207000043 |
| Provider Name | George M Despines |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811970759 PECOS PAC ID: 4486737129 Enrollment ID: I20080219000055 |
| Provider Name | Raymond Malcolm Smith |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1235125469 PECOS PAC ID: 2668550005 Enrollment ID: I20080424000699 |
| Provider Name | Nikolaos Michalacos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083697932 PECOS PAC ID: 2860565850 Enrollment ID: I20080724000253 |
| Provider Name | Isabel N Morais |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619963279 PECOS PAC ID: 7416021845 Enrollment ID: I20080804000333 |
| Provider Name | Derek Frederickson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1518184514 PECOS PAC ID: 4789758616 Enrollment ID: I20080811000323 |
| Provider Name | Caitlin Muething |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992970438 PECOS PAC ID: 4385719376 Enrollment ID: I20080827000115 |
| Provider Name | Jonathan B Croopnick |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1598871360 PECOS PAC ID: 3072681063 Enrollment ID: I20081003000372 |
| Provider Name | Christopher B Maiona |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205881042 PECOS PAC ID: 1254374531 Enrollment ID: I20081108000019 |
| Provider Name | Maher B El Khatib |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1194716829 PECOS PAC ID: 2668534306 Enrollment ID: I20081215000420 |
| Provider Name | Patricia E Kearney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578551818 PECOS PAC ID: 4688690241 Enrollment ID: I20090122000179 |
| Provider Name | Ida M Minevich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891780367 PECOS PAC ID: 8628132420 Enrollment ID: I20090122000477 |
| Provider Name | Alberto Yu Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952396624 PECOS PAC ID: 7517021389 Enrollment ID: I20090123000265 |
| Provider Name | Shaw R Natan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1669688784 PECOS PAC ID: 6204929672 Enrollment ID: I20090203000416 |
| Provider Name | Richard B Zelman |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1518904267 PECOS PAC ID: 9537225081 Enrollment ID: I20090306000522 |
| Provider Name | Bronie Gorelik |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194712422 PECOS PAC ID: 0446307748 Enrollment ID: I20090402000050 |
| Provider Name | Michael G Hamrock |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538156880 PECOS PAC ID: 3476601618 Enrollment ID: I20090428000365 |
| Provider Name | Abbas S Zaidi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598752834 PECOS PAC ID: 8921156019 Enrollment ID: I20090429000263 |
| Provider Name | John Ferrante |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649269523 PECOS PAC ID: 2466500061 Enrollment ID: I20090509000032 |
| Provider Name | Waqar A Cheema |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1902888332 PECOS PAC ID: 9638228067 Enrollment ID: I20090514000222 |
| Provider Name | Danielle C Stare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780645069 PECOS PAC ID: 3870643307 Enrollment ID: I20090604000162 |
| Provider Name | Courtney L Perette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164656732 PECOS PAC ID: 4587715446 Enrollment ID: I20090706000542 |
| Provider Name | Christannah Waters |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1104050681 PECOS PAC ID: 8729134507 Enrollment ID: I20090919000042 |
| Provider Name | Zsuzsa Kovacs |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053574459 PECOS PAC ID: 0749327385 Enrollment ID: I20091030000010 |
| Provider Name | Papa K Badoe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659359487 PECOS PAC ID: 5597741363 Enrollment ID: I20091111000066 |
| Provider Name | Albert A Ackil |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1083662332 PECOS PAC ID: 9739228933 Enrollment ID: I20091201000583 |
| Provider Name | Peter J Catalano |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1912091000 PECOS PAC ID: 9133263924 Enrollment ID: I20100217000370 |
| Provider Name | Yaakov Y Weinreb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528049400 PECOS PAC ID: 4385779339 Enrollment ID: I20100317000063 |
| Provider Name | Muhammad S Mowla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720286289 PECOS PAC ID: 8628109683 Enrollment ID: I20100708000594 |
| Provider Name | Brian C Dressel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760565873 PECOS PAC ID: 2769534064 Enrollment ID: I20100909000319 |
| Provider Name | Eugene L Vaninov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467425280 PECOS PAC ID: 0042335895 Enrollment ID: I20100916000571 |
| Provider Name | Sharon Bassi |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1033388277 PECOS PAC ID: 7911191135 Enrollment ID: I20101102000556 |
| Provider Name | Richard I Popovic |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407846579 PECOS PAC ID: 7719174150 Enrollment ID: I20101210000064 |
| Provider Name | Stephany T Godfrey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124179429 PECOS PAC ID: 7911188495 Enrollment ID: I20110316000120 |
| Provider Name | Deepak Kumar Sanan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902803950 PECOS PAC ID: 9133105166 Enrollment ID: I20110512000809 |
| Provider Name | David J Harrington |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205819000 PECOS PAC ID: 6103983549 Enrollment ID: I20110531000201 |
| Provider Name | Rohan C Wijewickrama |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1720210800 PECOS PAC ID: 2860661329 Enrollment ID: I20110818000066 |
| Provider Name | Noreen Iqbal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386808210 PECOS PAC ID: 3779753199 Enrollment ID: I20110823000255 |
| Provider Name | Prathima Chaloori |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760444137 PECOS PAC ID: 5193789832 Enrollment ID: I20110921000326 |
| Provider Name | Alena G Goldman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1528388303 PECOS PAC ID: 6507037447 Enrollment ID: I20110926000225 |
| Provider Name | Nicole M Leger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013296169 PECOS PAC ID: 5799958781 Enrollment ID: I20111108000564 |
| Provider Name | Shilpa Monga |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1528358090 PECOS PAC ID: 8820262074 Enrollment ID: I20111128000172 |
| Provider Name | Abigail Seely Butler |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1154605459 PECOS PAC ID: 6204002314 Enrollment ID: I20111220000435 |
| Provider Name | Manisha Sharma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760775720 PECOS PAC ID: 6507026333 Enrollment ID: I20120402000084 |
| Provider Name | Jairam R Eswara |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1659576189 PECOS PAC ID: 9133387954 Enrollment ID: I20120706000507 |
| Provider Name | Rachel E Resendes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760765499 PECOS PAC ID: 9032375381 Enrollment ID: I20120731000786 |
| Provider Name | Scott G Prushik |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1477660058 PECOS PAC ID: 4688830938 Enrollment ID: I20120801000009 |
| Provider Name | Mena M Mesiha |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1396928669 PECOS PAC ID: 1759538143 Enrollment ID: I20120820000630 |
| Provider Name | Marilyn H Heng |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1386903805 PECOS PAC ID: 6002067782 Enrollment ID: I20121105000621 |
| Provider Name | George Vardoulias |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750689840 PECOS PAC ID: 2466601174 Enrollment ID: I20121217000375 |
| Provider Name | Tammy L Steele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780931535 PECOS PAC ID: 4587809736 Enrollment ID: I20130318000452 |
| Provider Name | Gopakumar S Sreekumaran Nair |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811201841 PECOS PAC ID: 8527206994 Enrollment ID: I20130701000113 |
| Provider Name | Hugo R Castellanos Mendez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669602553 PECOS PAC ID: 0244472843 Enrollment ID: I20130812000183 |
| Provider Name | Suja Sadasivan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881822021 PECOS PAC ID: 4688817901 Enrollment ID: I20130905000167 |
| Provider Name | Kristina B Mulcahy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760732473 PECOS PAC ID: 8325282064 Enrollment ID: I20130918000557 |
| Provider Name | Zacharo Moditi |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1356461305 PECOS PAC ID: 2769506617 Enrollment ID: I20131004000432 |
| Provider Name | Saba Khokhar |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1518133602 PECOS PAC ID: 3971656547 Enrollment ID: I20131206000345 |
| Provider Name | Houtan Golzari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407946767 PECOS PAC ID: 3274515515 Enrollment ID: I20131216000043 |
| Provider Name | Farah Mullah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013935329 PECOS PAC ID: 7911145735 Enrollment ID: I20131219000087 |
| Provider Name | Lisa Marie Ryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831531045 PECOS PAC ID: 6305075912 Enrollment ID: I20140131000012 |
| Provider Name | Katia C Korte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083942270 PECOS PAC ID: 5890924872 Enrollment ID: I20140218000139 |
| Provider Name | Alireza Vaziri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619182714 PECOS PAC ID: 8729157730 Enrollment ID: I20140225001329 |
| Provider Name | Neil D Ravin |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1043304249 PECOS PAC ID: 2668550914 Enrollment ID: I20140227001168 |
| Provider Name | Shruti Biyani |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1013159292 PECOS PAC ID: 0446487409 Enrollment ID: I20140228001201 |
| Provider Name | Ashley Simoni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801222831 PECOS PAC ID: 3577793801 Enrollment ID: I20140305001389 |
| Provider Name | Richard D. Patten |
|---|---|
| Provider Type | Practitioner - Advanced Heart Failure And Transplant Cardiology |
| Provider Identifiers | NPI Number: 1992813042 PECOS PAC ID: 8224193859 Enrollment ID: I20140319000714 |
| Provider Name | Alexander Griffin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417104902 PECOS PAC ID: 1658552609 Enrollment ID: I20140320000013 |
| Provider Name | Riad Ettunsi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073828893 PECOS PAC ID: 4688805906 Enrollment ID: I20140328001457 |
| Provider Name | Kimberly A Moniz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558794651 PECOS PAC ID: 7618108887 Enrollment ID: I20140401001883 |
| Provider Name | Saroj N Purohit |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1902108160 PECOS PAC ID: 5991923658 Enrollment ID: I20140822000380 |
| Provider Name | Yelizaveta Vaynshteyn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1942431317 PECOS PAC ID: 7012139264 Enrollment ID: I20141104001046 |
| Provider Name | Anna Keshishyan |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1265840086 PECOS PAC ID: 2466674916 Enrollment ID: I20141118000111 |
| Provider Name | Stephen P Kajencki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073521753 PECOS PAC ID: 6103813191 Enrollment ID: I20141121000201 |
| Provider Name | Iris J Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932452513 PECOS PAC ID: 4789909839 Enrollment ID: I20150211002002 |
| Provider Name | Romie N Mundy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407098593 PECOS PAC ID: 7214177906 Enrollment ID: I20150324001208 |
| Provider Name | Maboh Q R Achiri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134526676 PECOS PAC ID: 3173840311 Enrollment ID: I20150326001408 |
| Provider Name | Rachel Tagoe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669600482 PECOS PAC ID: 6305091521 Enrollment ID: I20150527000360 |
| Provider Name | Davinderpal Singh |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1265712236 PECOS PAC ID: 3779714555 Enrollment ID: I20150831001945 |
| Provider Name | David A Sipala |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1821351263 PECOS PAC ID: 9335456342 Enrollment ID: I20150923000752 |
| Provider Name | Sarah Muchai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760861918 PECOS PAC ID: 5799093597 Enrollment ID: I20150928002455 |
| Provider Name | Tisha N Dickey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588984264 PECOS PAC ID: 0446490825 Enrollment ID: I20151005000644 |
| Provider Name | Amna Diwan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1518162189 PECOS PAC ID: 0547438970 Enrollment ID: I20151112000749 |
| Provider Name | Jennifer S Andrade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144696642 PECOS PAC ID: 8820398142 Enrollment ID: I20151118001081 |
| Provider Name | Sara La Grange |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477873792 PECOS PAC ID: 8426353855 Enrollment ID: I20160223002370 |
| Provider Name | Andrew H Moraco |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1740500560 PECOS PAC ID: 1850698077 Enrollment ID: I20160425000690 |
| Provider Name | Jolly S Abeskheron |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033476627 PECOS PAC ID: 9436440732 Enrollment ID: I20160616001049 |
| Provider Name | Hollie A O'bryan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104278704 PECOS PAC ID: 5890074280 Enrollment ID: I20161107001602 |
| Provider Name | Jennifer M Luz |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1558659482 PECOS PAC ID: 0446403679 Enrollment ID: I20161128001533 |
| Provider Name | Mailaja Mohammed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881130144 PECOS PAC ID: 4082998588 Enrollment ID: I20170308000816 |
| Provider Name | Angela Karavasilis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215967955 PECOS PAC ID: 9931191624 Enrollment ID: I20170523001988 |
| Provider Name | Lauren H Blackington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336519651 PECOS PAC ID: 5193093813 Enrollment ID: I20170621000316 |
| Provider Name | Tashia Kiara Prince-lacombe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487194833 PECOS PAC ID: 2567731052 Enrollment ID: I20170626002462 |
| Provider Name | Matthew T Lemaitre |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1184821266 PECOS PAC ID: 4587820337 Enrollment ID: I20170717001645 |
| Provider Name | Julie M Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326573387 PECOS PAC ID: 3971875857 Enrollment ID: I20170828002679 |
| Provider Name | Harold P Dietzius |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1649253790 PECOS PAC ID: 5597849646 Enrollment ID: I20171113002771 |
| Provider Name | Kara Birch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750893582 PECOS PAC ID: 1456619568 Enrollment ID: I20171219002215 |
| Provider Name | David Goldberg |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1053397810 PECOS PAC ID: 1759346091 Enrollment ID: I20180314001794 |
| Provider Name | Julie M Stone |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1851710081 PECOS PAC ID: 1557680642 Enrollment ID: I20180608000454 |
| Provider Name | Joshua M Arkin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1821315060 PECOS PAC ID: 0143460915 Enrollment ID: I20180620000117 |
| Provider Name | Saba Beg |
|---|---|
| Provider Type | Practitioner - Rheumatology |
| Provider Identifiers | NPI Number: 1982857793 PECOS PAC ID: 6608005269 Enrollment ID: I20180620000828 |
| Provider Name | Sadip Pant |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1205124724 PECOS PAC ID: 1355563412 Enrollment ID: I20180731001837 |
| Provider Name | Peguy Sylvain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679008783 PECOS PAC ID: 5991053928 Enrollment ID: I20180807002019 |
| Provider Name | Sarah Moses |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1093133555 PECOS PAC ID: 5890096283 Enrollment ID: I20181001002728 |
| Provider Name | Nicole Janel Correale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225578982 PECOS PAC ID: 7719239771 Enrollment ID: I20181003000813 |
| Provider Name | Laurie Reeder |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1740222744 PECOS PAC ID: 9739130782 Enrollment ID: I20181031000753 |
| Provider Name | Erica Goulston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003214388 PECOS PAC ID: 4789923376 Enrollment ID: I20190226001180 |
| Provider Name | Krupa Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669868592 PECOS PAC ID: 1456600774 Enrollment ID: I20190612001073 |
| Provider Name | Amen Ness |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1679670764 PECOS PAC ID: 7911942776 Enrollment ID: I20190806001234 |
| Provider Name | Kathleen E Genetti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245897263 PECOS PAC ID: 0244560027 Enrollment ID: I20190920000557 |
| Provider Name | Jessica Rose Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174006506 PECOS PAC ID: 6800126061 Enrollment ID: I20191001002658 |
| Provider Name | Kristen Alice Derderian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407417645 PECOS PAC ID: 8022442326 Enrollment ID: I20191219000953 |
| Provider Name | Lindsay J Kaplan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073166393 PECOS PAC ID: 4486081585 Enrollment ID: I20200303000193 |
| Provider Name | Charu K. Jain |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720214349 PECOS PAC ID: 4183888969 Enrollment ID: I20200324002066 |
| Provider Name | William Goodman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073619151 PECOS PAC ID: 6709824030 Enrollment ID: I20200512003053 |
| Provider Name | Dustin Powell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1669854808 PECOS PAC ID: 5395162663 Enrollment ID: I20200901001668 |
| Provider Name | Hector L Osoria |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1780071647 PECOS PAC ID: 2264747930 Enrollment ID: I20201129000031 |
| Provider Name | Shannon E Houlihan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215561949 PECOS PAC ID: 2163835935 Enrollment ID: I20210115001943 |
| Provider Name | Katelyn E Kenny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962027813 PECOS PAC ID: 5698181246 Enrollment ID: I20210308000583 |
| Provider Name | Kristine Ziemba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942242250 PECOS PAC ID: 0648203844 Enrollment ID: I20210317000163 |
| Provider Name | Melissa Sylvia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932752516 PECOS PAC ID: 2062820020 Enrollment ID: I20210413000945 |
| Provider Name | Danilo Decio |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1912344581 PECOS PAC ID: 9537582903 Enrollment ID: I20210419002248 |
| Provider Name | Ashley L Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942882857 PECOS PAC ID: 4183020266 Enrollment ID: I20210915002432 |
| Provider Name | Nonna Kolomeyevskaya |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1962708644 PECOS PAC ID: 7719281559 Enrollment ID: I20211206000763 |
| Provider Name | Richard D. Patten |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1992813042 PECOS PAC ID: 8224193859 Enrollment ID: I20220413002345 |
| Provider Name | Briana Marie Cody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003583626 PECOS PAC ID: 4789062415 Enrollment ID: I20220608000675 |
| Provider Name | Kelly Lynn Steinmetz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235894502 PECOS PAC ID: 9436534773 Enrollment ID: I20220922000941 |
| Provider Name | Thy Ngoc Dang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174185094 PECOS PAC ID: 9335515592 Enrollment ID: I20221013001630 |
| Provider Name | Hossein Keyhan |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1568003754 PECOS PAC ID: 7911339197 Enrollment ID: I20221220001572 |
| Provider Name | Cynthia Burns Robertson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467191601 PECOS PAC ID: 3971974015 Enrollment ID: I20230127000326 |
| Provider Name | Zachary Tataryn |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1518251834 PECOS PAC ID: 5193015493 Enrollment ID: I20230203000471 |
| Provider Name | Terrence Li |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1144484619 PECOS PAC ID: 6800065426 Enrollment ID: I20230510001081 |
| Provider Name | William Howe |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1629159835 PECOS PAC ID: 6507931391 Enrollment ID: I20230711000285 |
| Provider Name | Chamoune Alce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912635681 PECOS PAC ID: 2264886555 Enrollment ID: I20230920001180 |
| Provider Name | Benjamin Horn |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1124471685 PECOS PAC ID: 7517293574 Enrollment ID: I20230928003288 |
| Provider Name | Maureen Onuigbo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972586592 PECOS PAC ID: 6507893468 Enrollment ID: I20231012001756 |
| Provider Name | Penelope Kagan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194341008 PECOS PAC ID: 3476977331 Enrollment ID: I20231027002009 |
| Provider Name | Stephen Roger Addington |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821449588 PECOS PAC ID: 7416210844 Enrollment ID: I20231101002713 |
| Provider Name | Mark P Tallman |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1174518989 PECOS PAC ID: 6406878305 Enrollment ID: I20231117003002 |
| Provider Name | Elizabeth Blocker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003696550 PECOS PAC ID: 7113379611 Enrollment ID: I20240119004061 |
| Provider Name | Victoria Lynn Gray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245939933 PECOS PAC ID: 1456701697 Enrollment ID: I20240220004608 |
| Provider Name | Zipporah Waithaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508549320 PECOS PAC ID: 2466899976 Enrollment ID: I20240320000584 |
| Provider Name | Leisa Maxwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154434462 PECOS PAC ID: 8527105808 Enrollment ID: I20240815001947 |
| Provider Name | David H Ma |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659722312 PECOS PAC ID: 8527321959 Enrollment ID: I20241001003695 |
| Provider Name | Lei Pei |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1053773606 PECOS PAC ID: 7315232170 Enrollment ID: I20250214000930 |
| Provider Name | Kelly Garrity |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790592301 PECOS PAC ID: 1850812272 Enrollment ID: I20250303000074 |
Healing Hearts Holistically Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 348 North Pearl St, Brockton, MA 02301 Phone: 508-584-3278 Fax: 508-584-3279 | |
Brockton Area Multi-services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 Pleasant St, Brockton, MA 02301 Phone: 508-586-5977 Fax: 508-583-5847 | |
Esp Med Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 830 Oak St, Suite 102w, Brockton, MA 02301 Phone: 508-897-4790 Fax: 508-897-4778 | |
Esp Medical Bilh Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 830 Oak St Ste 102w, Brockton, MA 02301 Phone: 508-521-9259 Fax: 844-823-0453 | |
Freccero Medical Associates Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 77 Byron Ave, Brockton, MA 02301 Phone: 508-583-7595 Fax: 508-559-2278 | |
Gis Services 2, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 189 Quincy St, Brockton, MA 02302 Phone: 508-588-6700 Fax: 508-584-3010 | |
Ambama Clinic Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 56 Cottage Grove Ave, Brockton, MA 02301 Phone: 617-296-0720 Fax: 617-296-5166 |