Healthcare Provider Details

I. General information

NPI: 1376618256
Provider Name (Legal Business Name): ALENA ASHENBERG M.D. PEDIATRICS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NASHUA RD
DRACUT MA
01826-1929
US

IV. Provider business mailing address

505 NASHUA RD
DRACUT MA
01826-1929
US

V. Phone/Fax

Practice location:
  • Phone: 978-957-4300
  • Fax: 978-957-3891
Mailing address:
  • Phone: 978-957-4300
  • Fax: 978-957-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77683
License Number StateMA

VIII. Authorized Official

Name: ALENA ASHENBERG
Title or Position: M.D.
Credential:
Phone: 978-957-4300