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SIGNATURE MEDICAL GROUP
NPI 1417932591
Clinic/Center - Multi-Specialty in Brockton, MA

Active since December 12, 2005
110 LIBERTY ST, BROCKTON, MA 02301(508) 894-0400(508) 565-0157 Get Directions Write a Review

NPPES record last updated: June 18, 2013. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Signature Medical Group NPPES

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

SIGNATURE MEDICAL GROUP (NPI 1417932591) is a healthcare organization registered as a multi-specialty in Brockton, Massachusetts and active in the NPI registry since December 2005. The organization lists Kim Hollon, Ceo, as its authorized official.

NPPES Registry Identity

NPI1417932591
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameBRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC.
Location Address110 LIBERTY STBrockton, MA 02301-5521
Mailing Address110 Liberty StBrockton, MA 02301-5521 · (508) 894-0400 · Fax (508) 565-0157
Phone(508) 894-0400
Fax(508) 565-0157
Organization SubpartNo
Authorized OfficialKim HollonCeo · (508) 941-7004
Enumeration DateDecember 12, 2005
Last NPPES UpdateJune 18, 2013
✔ NPI 1417932591 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
110 LIBERTY ST, Brockton, MA 02301
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Other Names 1

Doing Business AsSignature Medical Group

Other Identifiers 3

Medicare PINM20452MA
Medicaid110022141EMA
Medicare NSC4423010001MA

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.

MR. RICHARD DUONG PA-C
Physician Assistant
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 565-3055
MRS. RENA B LEVY MSN, FNP-BC
Nurse Practitioner (Family)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. KEVIN RAYMOND GENDREAU M.D.
Family Medicine (Obesity Medicine)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
XIN HE
Internal Medicine (Endocrinology, Diabetes & Metabolism)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. SENA J LEE MD
Dermatology
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 580-1020
NITA MEHTA MD
Ophthalmology
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. TARA SAMANTHA SWIM M.D.
Physical Medicine & Rehabilitation
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 565-3055
NATASHA BITA KHAZAI MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400

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 Bridgewater Goddard Park Medical Associates, Inc.'s NPI number?

The NPI number for Bridgewater Goddard Park Medical Associates, Inc. is 1417932591. It was assigned to this organization in the NPPES registry on December 12, 2005. The provider is doing business as Signature Medical Group.

Where is Bridgewater Goddard Park Medical Associates, Inc. located?

Bridgewater Goddard Park Medical Associates, Inc. is located at 110 Liberty St, Brockton, MA 02301. The listed phone number is (508) 894-0400.

What is Bridgewater Goddard Park Medical Associates, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

When was this NPI record last updated?

The NPPES record for Bridgewater Goddard Park Medical Associates, Inc. was last updated on June 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.