MEDICARE: PEDIATRIC ASSOCIATES OF GREATER SALEM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1134191125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ASSOCIATES OF GREATER SALEM, INC

Provider Business Mailing Address
First Line	:	30 TOZER RD STE 101
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-5510
Country	:	US
Telephone Number	:	978-745-3050
Fax Number	:	978-744-9594

Provider Business Practice Location Address
First Line	:	84 HIGHLAND AVE
Second Line	:	SUITE 101
City	:	SALEM
State	:	MA
Zip	:	01970-2727
Country	:	US
Telephone Number	:	978-745-3050
Fax Number	:	978-744-9594

Authorized Official
Title or Position	:	CFO
Name	:	MARK MCKENNA
Credential	:
Telephone Number	:	978-745-3050

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	01/08/2026

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