Healthcare Provider Details

I. General information

NPI: 1649269135
Provider Name (Legal Business Name): ESSEX MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ANDOVER ST SUITE 206
NORTH ANDOVER MA
01845-5044
US

IV. Provider business mailing address

4 WORTHEN PL
ANDOVER MA
01810-2846
US

V. Phone/Fax

Practice location:
  • Phone: 978-725-3636
  • Fax: 978-327-6827
Mailing address:
  • Phone:
  • Fax: 978-327-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number154422
License Number StateMA

VIII. Authorized Official

Name: DR. VANI SREE REDDI
Title or Position: OWNER
Credential: M.D.
Phone: 978-725-3636