Healthcare Provider Details

I. General information

NPI: 1710194410
Provider Name (Legal Business Name): PATRIOT PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 LOOMIS ST
BEDFORD MA
01730-2248
US

IV. Provider business mailing address

74 LOOMIS ST
BEDFORD MA
01730-2248
US

V. Phone/Fax

Practice location:
  • Phone: 781-674-2900
  • Fax:
Mailing address:
  • Phone: 781-674-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCINE HENNESSEY
Title or Position: OWNER
Credential: M.D.
Phone: 781-674-2900