Healthcare Provider Details

I. General information

NPI: 1427041268
Provider Name (Legal Business Name): BEVERLY ANESTHESIA ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MAPLE ST SUITE C233A
DANVERS MA
01923-4065
US

IV. Provider business mailing address

480 MAPLE ST SUITE C233A
DANVERS MA
01923-4065
US

V. Phone/Fax

Practice location:
  • Phone: 978-304-8690
  • Fax: 978-304-8697
Mailing address:
  • Phone: 978-304-8690
  • Fax: 978-304-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: JANICE E REYNOLDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-304-8690