Healthcare Provider Details

I. General information

NPI: 1861481301
Provider Name (Legal Business Name): DAVID P ST PIERRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 STATE RD
DANVERS MA
01923-2567
US

IV. Provider business mailing address

58 RIVER ST UNIT 2
DANVERS MA
01923-3378
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-3400
  • Fax: 978-774-5883
Mailing address:
  • Phone: 978-618-9231
  • Fax: 978-774-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number46461
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: