Healthcare Provider Details

I. General information

NPI: 1528085982
Provider Name (Legal Business Name): DANIELLE M LEDOUX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HERRICK ST STE 102
BEVERLY MA
01915-2734
US

IV. Provider business mailing address

77 HERRICK ST STE 102
BEVERLY MA
01915-2734
US

V. Phone/Fax

Practice location:
  • Phone: 978-338-4321
  • Fax: 978-927-1010
Mailing address:
  • Phone: 978-338-4321
  • Fax: 978-927-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number229695
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number229695
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: