Organization
CCCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE MCCORMACK (PRACTICE MANAGER)
(508) 778-8818
Entity
Organization
Contact information
Practice address
140 YARMOUTH RD, HYANNIS, MA 02601
(508) 778-8818
(508) 778-1003
Mailing address
140 YARMOUTH RD, HYANNIS, MA 02601
(508) 778-8818
(508) 778-1003
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
226058
MA
207RC0000X
Cardiovascular Disease Physician
40601
MA
207RC0000X
Cardiovascular Disease Physician
57050
MA
207RC0000X
Cardiovascular Disease Physician
Primary
72694
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9748610
—
MA
Enumeration date
01/12/2011
Last updated
01/12/2011
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