| Organization Name: | NORTHEAST MEDICAL PRACTICE INC |
| NPI Number: | 1073911509 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PHILIP CORMIER (CEO) |
| Mailing Address: | 500 Cummings Ctr Suite 6500 Beverly |
| State: | MA US |
| Postal Code: | 019156142 |
| Phone Number: | 9782361712 |
| Fax Number: | 9782361717 |
| NPI Enumeration Date: | 12/16/2014 |
| NPI Last Update Date: | 01/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |