Organization
FAULKNER EMERGENCY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD LARSON MD (PRESIDENT)
(617) 983-7132
Entity
Organization
Contact information
Practice address
1153 CENTRE ST, JAMAICA PLAIN, MA 02130-3446
(617) 983-7132
(617) 983-7834
Mailing address
6 LAKEVILLE BUSINESS PARK, LAKEVILLE, MA 02347-1234
(800) 984-9872
(508) 946-1494
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9783466
—
MA
01
—
M16935
BLUE SHIELD
MA
Enumeration date
12/12/2006
Last updated
08/22/2020
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