Healthcare Provider Details

I. General information

NPI: 1437510815
Provider Name (Legal Business Name): ANA TEREZA T. WESCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA TEREZA M. TONET

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FOSTER STREET PEABODY FAMILY HEALTH CENTER
PEABODY MA
01960
US

IV. Provider business mailing address

27 CONGRESS ST STE 513
SALEM MA
01970-5523
US

V. Phone/Fax

Practice location:
  • Phone: 978-532-4903
  • Fax: 978-532-4995
Mailing address:
  • Phone: 978-744-8388
  • Fax: 978-744-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL13892
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: