BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC. (NPI# 1417932591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417932591 |
| Entity Type | Organization |
| Organization Name | BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC. |
| Other Organization Name | SIGNATURE MEDICAL GROUP |
| Practice Address |
110 Liberty St Brockton MA 02301-5521 |
| Practice Telephone | 5088940400 |
| Practice Fax Number | 5085650157 |
| Mailing Telephone | 5088940400 |
| Mailing Fax Number | 5085650157 |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2013-06-18 |
| Authorized Official Name | MR. KIM HOLLON (CEO) |
| Authorized Official Telephone | 5089417004 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110022141E | 05 |
| Other Name | Type Code |
|---|---|
| Signature Medical Group | Doing Business As Name - Organization |
| Street Address |
110 LIBERTY ST |
| City | BROCKTON |
| State | MA |
| Zip Code | 02301-5521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164416186 | Aqeel Siddiqui | Surgery | 110 Liberty St, Brockton, MA 02301-5521 | 2005-09-06 |
| 1902404981 | Sara Louise Borrello | Dietitian, Registered | 110 Liberty St, Brockton, MA 02301-5674 | 2020-10-13 |
| 1134735392 | Meredith Celine Harrington | Physical Medicine & Rehabilitation | 110 Liberty St, Brockton, MA 02301-5674 | 2020-09-22 |
| 1356951784 | Adam S Donahue | Nurse Practitioner | 110 Liberty St, Brockton, MA 02301-5674 | 2020-07-31 |
| 1427603851 | Kristen Laura Barrett | Registered Nurse | 110 Liberty St, Brockton, MA 02301-5674 | 2019-08-02 |
| 1427611722 | Donovan Kelly | Specialist/Technologist | 110 Liberty St, Brockton, MA 02301-5674 | 2019-04-22 |
| 1316411481 | Cassandra Desjardins | Nurse Practitioner | 110 Liberty St, Brockton, MA 02301-5521 | 2019-01-11 |
| 1407353154 | Dean Robert Howell | Social Worker | 110 Liberty St, Brockton, MA 02301-5674 | 2018-04-10 |
| 1619473725 | Patricia L Ramanauskas | Technician/Technologist | 110 Liberty St, Brockton, MA 02301-5521 | 2018-04-05 |
| 1588182323 | Alicia Reid | Specialist/Technologist | 110 Liberty St, Brockton, MA 02301-5521 | 2017-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807110 | Jenny Vulpis | Recreation Therapist | 940 Belmont St (br 135), Brockton, MA 02301 | 2020-10-01 |
| 1205444924 | Caroline Storey | Counselor | Men's Addiction Treatment Center, 10 Meadowbrook Road, Brockton, MA 02301 | 2020-07-20 |
| 1013546852 | Nuria Dos Santos Veiga | Occupational Therapist | 73 Denton St, Brockton, MA 02301 | 2020-04-03 |
| 1679113930 | Laura Ann Brondyk II | Counselor | 10 Christys Dr, Brockton, MA 02301 | 2020-01-14 |
| 1437796521 | Andrea Lopes | Developmental Therapist | 7 Goddard Road, Brockton, MA 02301 | 2019-12-08 |
| 1518420124 | Diligencehealthcare | Psychiatry & Neurology | 30-40 Westpark Street, Brockton, MA 02301 | 2019-04-10 |
| 1124530373 | Rachel Theys | Behavioral Analyst | 130 Liberty St Ste 13a, Brockton, MA 02301 | 2017-10-27 |
| 1689193369 | Anderson D Delgado | Behavior Technician | 11 Packard Way, Brockton, MA 02301 | 2017-09-14 |
| 1811415326 | Francesca Lavecchia | Clinical Neuropsychologist | Brockto Area Multi Service, Inc. 10 Christy Dr., Brockton, MA 02301 | 2017-09-05 |
| 1831615343 | Donna Marie Dugan | Counselor | South Bay Community Services, 340 Main Street - Suite 818, Worcester, MA 02301 | 2017-08-16 |
| Find all providers in zip 02301 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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|---|---|---|---|---|
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| 1477073138 | Acorn Health Services, PC | Clinic/Center | 112 Main St Ste 104, Northborough, MA 01532-1914 | 2017-06-23 |
| 1992199830 | Massachusetts Integrated Care | Clinic/Center | 108 Grove St Ste 22, Worcester, MA 01605-2651 | 2015-03-27 |
| 1568851368 | Brain Fit Academy, Inc | Clinic/Center | 25 Westcott Rd, Hopedale, MA 01747-1824 | 2015-01-16 |
| 1689007908 | Convivial Dental PC | Clinic/Center | 1244 Boylston St Ste 205, Chestnut Hill, MA 02467-2115 | 2013-08-11 |
| 1265873582 | New England Muscular Therapy, LLC | Clinic/Center | 1458 Hancock St, Suite 220, Quincy, MA 02169-5214 | 2013-07-15 |
| 1558613026 | Salud Spine Joint and Wellness Center | Clinic/Center | 651 Orchard Street, Suite 202a, New Bedford, MA 02744 | 2012-10-09 |
| 1932455193 | Np House/clinic Calls, LLC | Clinic/Center | 31 Eric Dr, Pittsfield, MA 01201-8324 | 2012-07-25 |
| 1508082710 | Saltz Schulman & Gershengorn Ptr Cardiology Associates | Clinic/Center | 1101 Beacon St Fl 4, Brookline, MA 02446-5587 | 2007-04-17 |
| 1407079759 | North Shore Rehabilitation Associates Inc. | Clinic/Center | 121 Broad Street, Lynn, MA 01901-1629 | 2007-04-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.