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Organization
AMBAMA CLINIC PC
Active
Organization
AMBAMA CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHOK J PATEL M.D. (MANAGER)
(617) 296-0720
Entity
Organization
Contact information
Practice address
56 COTTAGE GROVE AVE, BROCKTON, MA 02301-6347
(617) 296-0720
(617) 296-5166
Mailing address
56 COTTAGE GROVE AVE, BROCKTON, MA 02301-6347
(617) 296-0720
(617) 296-5166
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
52194
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030542
NEIGHBORHOOD HEALTH PLAN
MA
01
—
697380
TUFTS HEALTH PLAN
MA
05
—
9728350
—
MA
01
—
DA4008
RAILROAD MEDICARE GROUP
MA
01
—
M18330
BLUE CROSS BLUE SHIELD MA
MA
Enumeration date
12/28/2006
Last updated
01/18/2008
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