Individual
DR. PHILLIP O FOURNIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF FAMILY MEDICINE, WORCESTER, MA 01655-0002
(508) 856-2818
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
60338
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3076091
—
MA
Enumeration date
11/25/2005
Last updated
10/30/2020
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