| Wayland Personal Physicians Pllc | |
|
109 Andrew Ave Suite 203 Wayland MA 01778-3157 | |
| (508) 358-3300 | |
| (508) 358-2300 |
| Full Name | Wayland Personal Physicians Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 109 Andrew Ave, Wayland, Massachusetts |
| Authorized Official Name and Position | Fred Goldman (OWNER) |
| Authorized Official Contact | 5083583300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wayland Personal Physicians Pllc 109 Andrew Ave Suite 203 Wayland MA 01778-3157 Ph: (508) 358-3300 | Wayland Personal Physicians Pllc 109 Andrew Ave Suite 203 Wayland MA 01778-3157 Ph: (508) 358-3300 |
| NPI Number | 1710422373 |
|---|---|
| Provider Enumeration Date | 01/05/2017 |
| Last Update Date | 04/18/2017 |
| Medicare PECOS PAC ID | 7719269588 |
|---|---|
| Medicare Enrollment ID | O20170131002622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710422373 | NPI | - | NPPES |
| 110120655A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Massachusetts) | Primary |
| Provider Name | Jonathan G Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023057015 PECOS PAC ID: 5991609372 Enrollment ID: I20031126000428 |
| Provider Name | Frederic M Goldman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982642260 PECOS PAC ID: 8820061971 Enrollment ID: I20040817000410 |