Healthcare Provider Details

I. General information

NPI: 1467594101
Provider Name (Legal Business Name): NORTH ANDOVER PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820A TURNPIKE ST JEFFERSON OFFICE PARK
NORTH ANDOVER MA
01845-6124
US

IV. Provider business mailing address

820A TURNPIKE ST JEFFERSON OFFICE PARK
NORTH ANDOVER MA
01845-6124
US

V. Phone/Fax

Practice location:
  • Phone: 978-557-5712
  • Fax: 978-557-5406
Mailing address:
  • Phone: 978-557-5712
  • Fax: 978-557-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL MCELENEY
Title or Position: BILLING MANAGER
Credential:
Phone: 781-638-1024