Healthcare Provider Details

I. General information

NPI: 1134191125
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF GREATER SALEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HIGHLAND AVE SUITE 101
SALEM MA
01970-2727
US

IV. Provider business mailing address

30 TOZER RD STE 101
BEVERLY MA
01915-5510
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-3050
  • Fax: 978-744-9594
Mailing address:
  • Phone: 978-745-3050
  • Fax: 978-744-9594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK MCKENNA
Title or Position: CFO
Credential:
Phone: 978-745-3050