Healthcare Provider Details

I. General information

NPI: 1376114082
Provider Name (Legal Business Name): PAMILLI LEANDRO BEZERRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73D WINTHROP AVE
LAWRENCE MA
01843-3716
US

IV. Provider business mailing address

73D WINTHROP AVE
LAWRENCE MA
01843-3716
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-3017
  • Fax: 978-687-1947
Mailing address:
  • Phone: 978-686-3017
  • Fax: 978-687-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1018886
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: