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Contact Information

AMBAMA CLINIC PC
56 COTTAGE GROVE AVE
BROCKTON, MA02301-6347
 Phone: 617-296-0720
 Fax: 617-296-5166
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adolescent Medicine

207RA0000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for AMBAMA CLINIC PC · (Female)

NPI # 1205992989
Status Active
Credentials
Entity Individual
Enumeration date 12/28/2006
Last updated 01/18/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • MA License # 52194
  • MA Medicaid 9728350
  • MA Other M18330 BLUE CROSS BLUE SHIELD MA
  • MA Other 0030542 NEIGHBORHOOD HEALTH PLAN
  • MA Other DA4008 RAILROAD MEDICARE GROUP
  • MA Other 697380 TUFTS HEALTH PLAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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