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NPI Code Detail

MEDICARE: DR. ANN NUTT MD

MEDICARE: DR. ANN NUTT MD
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
1208000000XPediatrics Physician73019MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346225281
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANN NUTT MD
Provider Business Mailing Address
First Line : 1135 MORTON ST
Second Line :
City : MATTAPAN
State : MA
Zip : 02126-2834
Country : US
Telephone Number : 617-533-2300
Fax Number : 617-533-2341
Provider Business Practice Location Address
First Line : 398 NEPONSET AVE
Second Line :
City : DORCHESTER
State : MA
Zip : 02122-3134
Country : US
Telephone Number : 617-282-3200
Fax Number : 617-282-8201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 11/09/2011

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