Individual
JOHN P. BROACH II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 421-1400
(508) 421-1490
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
241404
MA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
241404
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110083615A
—
MA
Enumeration date
01/10/2007
Last updated
11/09/2020
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