SIGNATURE HEALTHCARE BROCKTON HOSPITAL
NPI 1174560304
Internal Medicine in Brockton, MA

Q: What is Brockton Hospital Specialty Physician Group's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since May 31, 2006

680 CENTRE ST, BROCKTON, MA 02302(508) 941-7062(508) 941-6337 Get Directions Write a Review

NPPES record last updated: December 22, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Signature Healthcare Brockton Hospital NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIGNATURE HEALTHCARE BROCKTON HOSPITAL (NPI 1174560304) is a healthcare organization registered as an internal medicine in Brockton, Massachusetts and active in the NPI registry since May 2006. The organization lists Eugene C. Wallace, Ceo, as its authorized official.

NPPES Registry Identity

NPI1174560304

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameBROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP

Location Address680 CENTRE STBrockton, MA 02302-3308

Mailing AddressPo Box 847493Boston, MA 02284-7493 · (508) 565-0147 · Fax (508) 565-0157

Phone(508) 941-7062

Fax(508) 941-6337

Organization SubpartNo

Authorized OfficialEugene C. WallaceCeo · (508) 941-7062

Enumeration DateMay 31, 2006

Last NPPES UpdateDecember 22, 2009

✔ NPI 1174560304 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X

Also ListedAnesthesiology · Pain MedicineTaxonomy 207LP2900X

Also ListedEmergency MedicineTaxonomy 207P00000X

Also ListedInternal Medicine · Cardiovascular DiseaseTaxonomy 207RC0000X

Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X

Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X

Also ListedInternal Medicine · Pulmonary DiseaseTaxonomy 207RP1001X

Also ListedInternal Medicine · RheumatologyTaxonomy 207RR0500X

Also ListedObstetrics & GynecologyTaxonomy 207V00000X

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X

Also ListedPediatricsTaxonomy 208000000X

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X

Also ListedSurgeryTaxonomy 208600000X

Also ListedHospitalistTaxonomy 208M00000X

680 CENTRE ST, Brockton, MA 02302

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Other Names 1

Doing Business AsSignature Healthcare Brockton Hospital

Other Identifiers 3

Medicaid9757350MA

OtherM19115MA · Bcbs Group #

Medicare ID-Type UnspecifiedM21752MA · Group #

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LOUIS D. GOTTLIEB M.D.

Internal Medicine

680 CENTRE ST, MANAGED CARE
BROCKTON, MA 02302

Plymouth County (508) 941-7065

MS. JAMIE CHYAT PA-C

Physician Assistant

680 CENTRE ST
BROCKTON, MA 02302

Plymouth County (508) 941-7000

BRANDEN M TURNER LMHC

Counselor (Mental Health)

680 CENTRE ST
BROCKTON, MA 02302

Plymouth County (508) 941-7228

CARLY ALEXANDRA CARLIN MD

Psychiatry & Neurology (Psychiatry)

680 CENTRE ST
BROCKTON, MA 02302

Plymouth County (508) 941-7228

DR. ANGEL TAYLOR MD

Student in an Organized Health Care Education/Training Program

680 CENTRE ST
BROCKTON, MA 02302

Plymouth County (508) 974-7000

DR. DESIREE A CARLSON MD

Pathology (Anatomic Pathology & Clinical Pathology)

680 CENTRE ST, PATHOLOGY DEPARTMENT
BROCKTON, MA 02302

Plymouth County (508) 941-7414

DEMIN MA M.D.

Psychiatry & Neurology (Psychiatry)

680 CENTRE ST
BROCKTON, MA 02302

Plymouth County (508) 941-7228

JENNIFER L. BUNKER

Social Worker

680 CENTRE ST
BROCKTON, MA 02302

Plymouth County (508) 941-7268

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brockton Hospital Specialty Physician Group's NPI number?

The NPI number for Brockton Hospital Specialty Physician Group is 1174560304. It was assigned to this organization in the NPPES registry on May 31, 2006. The provider is doing business as Signature Healthcare Brockton Hospital.

Where is Brockton Hospital Specialty Physician Group located?

Brockton Hospital Specialty Physician Group is located at 680 Centre St, Brockton, MA 02302. The listed phone number is (508) 941-7062.

What is Brockton Hospital Specialty Physician Group's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Brockton Hospital Specialty Physician Group was last updated on December 22, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.