Healthcare Provider Details

I. General information

NPI: 1003805540
Provider Name (Legal Business Name): ORTHOPAEDICS NORTHEAST P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 TURNPIKE ST SUITE 11
N ANDOVER MA
01845-5924
US

IV. Provider business mailing address

575 TURNPIKE ST SUITE 11
N ANDOVER MA
01845-5924
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-1946
  • Fax: 978-975-3925
Mailing address:
  • Phone: 978-794-1946
  • Fax: 978-975-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL LEAHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-327-6561