Healthcare Provider Details

I. General information

NPI: 1174765994
Provider Name (Legal Business Name): DEDHAM MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LYONS ST
DEDHAM MA
02026-5599
US

IV. Provider business mailing address

1 LYONS ST
DEDHAM MA
02026-5599
US

V. Phone/Fax

Practice location:
  • Phone: 781-329-1400
  • Fax: 781-278-5664
Mailing address:
  • Phone: 781-329-1400
  • Fax: 781-278-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE DAVIS
Title or Position: MANAGER
Credential:
Phone: 781-278-5512