Provider Demographics
NPI:1861693426
Name:WELLESLEY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:WELLESLEY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:DUPEE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:781-235-9089
Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-235-9089
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 440
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-235-9089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34539207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9748814Medicaid
MACM5415OtherRAILROAD MEDICARE
MAM15161OtherBLUE CROSS BLUE SHIELD
MA600422OtherTUFTS
MA600422OtherTUFTS