Dr. Peggy Mentor
Family Doctor - Geriatric Medicine
63 Main St
Brockton
, Massachusetts 02301-4042
Dr. Peggy Mentor
Family Doctor - Geriatric Medicine
63 Main St
Brockton
, Massachusetts 02301-4042
(508) 559-5073
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About
Features
Specialties
- Family Doctor - Geriatric Medicine
Languages spoken
- English
Location
First Address
- Dr. Peggy Mentor
- 63 Main St
- Brockton, MA
- Zip : 02301-4042
- Fax : (508) 559-5073
- Phone : (508) 559-6699
Second Address
- Dr. Peggy Mentor
- 63 Main St
- Brockton, MA
- Zip : 02301-4042
- Fax : (508) 559-5073
- Phone : (508) 559-6699
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207QG0300X | Family Doctor - Geriatric Medicine | 262150 | MA |
| N | 207QG0300X | Family Doctor - Geriatric Medicine | C53573 | CA |
National Provider Identifier
| NPI | 1023006525 |
|---|---|
| Provider Name | Dr. Peggy Mentor |
| First Address | Brockton, MA 02301-4042 |
| Second Address | Brockton, MA 02301-4042 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/10/2005 |
| Last Update Date | 12/07/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1023006525 | (05) | CA |
| H198100 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.