Provider Demographics
NPI:1902889272
Name:WOBURN MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:WOBURN MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-988-9255
Mailing Address - Street 1:500 SALEM ST
Mailing Address - Street 2:WOBURN MEDICAL ASSOCIATES PC
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1200
Mailing Address - Country:US
Mailing Address - Phone:978-988-9255
Mailing Address - Fax:978-694-9675
Practice Address - Street 1:500 SALEM ST
Practice Address - Street 2:WOBURN MEDICAL ASSOCIATES PC
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1200
Practice Address - Country:US
Practice Address - Phone:978-988-9255
Practice Address - Fax:978-694-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9764852Medicaid
600386OtherTUFTS
M15271OtherBCBS
600386OtherTUFTS