Provider Demographics
NPI:1144497256
Name:DRUM HILL PRIMARY CARE LLC
Entity type:Organization
Organization Name:DRUM HILL PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAZALA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-452-0052
Mailing Address - Street 1:4 COURTHOUSE LANE, SUITE 1-3
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1738
Mailing Address - Country:US
Mailing Address - Phone:978-452-0052
Mailing Address - Fax:
Practice Address - Street 1:4 COURTHOUSE LANE, SUITE 1-3
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1738
Practice Address - Country:US
Practice Address - Phone:978-452-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA43543OtherFALLON
MA710744OtherHARVARD PILGRIM
MA0101172OtherUNITED HEALTHCARE
MA3201449Medicaid
MA158508OtherTUFTS
MAM17731OtherBLUE CROSS BLUE SHIELD MASSACHUSETTS
MAB10379801OtherCIGNA
MA5324329OtherAETNA
MA158508OtherTUFTS