Healthcare Provider Details

I. General information

NPI: 1285146258
Provider Name (Legal Business Name): PEDIATRIC HEALTH CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTENNIAL DR
PEABODY MA
01960-7938
US

IV. Provider business mailing address

10 CENTENNIAL DR
PEABODY MA
01960-7938
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-1110
  • Fax: 978-535-2907
Mailing address:
  • Phone: 978-535-1110
  • Fax: 978-535-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBORA A HARDING
Title or Position: COO
Credential:
Phone: 781-729-3008