| Form Health Associates, P.c. | |
|
179 Lincoln St Fl 4 Boston MA 02111-2424 | |
| (617) 505-1520 | |
| Not Available |
| Full Name | Form Health Associates, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 179 Lincoln St Fl 4, Boston, Massachusetts |
| Authorized Official Name and Position | Nam Ho Kim (PRESIDENT) |
| Authorized Official Contact | 6175051520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Form Health Associates, P.c. 179 Lincoln St Ste 404 Boston MA 02111-2425 Ph: (617) 505-1520 | Form Health Associates, P.c. 179 Lincoln St Fl 4 Boston MA 02111-2424 Ph: (617) 505-1520 |
| NPI Number | 1043835044 |
|---|---|
| Provider Enumeration Date | 06/15/2020 |
| Last Update Date | 02/24/2022 |
| Medicare PECOS PAC ID | 0244641272 |
|---|---|
| Medicare Enrollment ID | O20201124001275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043835044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Michelle Cao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003129842 PECOS PAC ID: 9638328370 Enrollment ID: I20121012000428 |
| Provider Name | Lauren Marshall Lemieux |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912393463 PECOS PAC ID: 5799030458 Enrollment ID: I20180620002233 |
| Provider Name | Nathaniel M Pedley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669978532 PECOS PAC ID: 4486082898 Enrollment ID: I20210622003552 |
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