Healthcare Provider Details

I. General information

NPI: 1669667234
Provider Name (Legal Business Name): ANNA PETROPOULOS WEISSLEDER, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LINDALL ST STE 2
DANVERS MA
01923-2135
US

IV. Provider business mailing address

80 LINDALL ST STE 2
DANVERS MA
01923-2135
US

V. Phone/Fax

Practice location:
  • Phone: 978-739-9500
  • Fax: 978-739-9502
Mailing address:
  • Phone: 978-739-9500
  • Fax: 978-739-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number154747
License Number StateMA

VIII. Authorized Official

Name: DR. ANNA PETROPOULOS WEISSLEDER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 978-739-9500