Healthcare Provider Details

I. General information

NPI: 1073501649
Provider Name (Legal Business Name): FRANK X. PEDLOW JR, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LANCASTER ST 2ND FLR
BOSTON MA
02114-1704
US

IV. Provider business mailing address

PO BOX 86
HINGHAM MA
02043-0086
US

V. Phone/Fax

Practice location:
  • Phone: 617-227-9300
  • Fax: 617-227-3800
Mailing address:
  • Phone: 781-749-9071
  • Fax: 781-749-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number79694
License Number StateMA

VIII. Authorized Official

Name: FRANK X PEDLOW JR.
Title or Position: OWNER
Credential: M.D.
Phone: 617-227-9300