Healthcare Provider Details

I. General information

NPI: 1437171576
Provider Name (Legal Business Name): NORTH SHORE CARDIOVASCULAR ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-5900
  • Fax: 978-745-9534
Mailing address:
  • Phone: 978-744-5900
  • Fax: 978-745-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK R ANDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 978-744-5900