Healthcare Provider Details

I. General information

NPI: 1972113637
Provider Name (Legal Business Name): AAP - WPHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WOODLAND RD STE 217
STONEHAM MA
02180-1711
US

IV. Provider business mailing address

3 WOODLAND RD STE 217
STONEHAM MA
02180-1711
US

V. Phone/Fax

Practice location:
  • Phone: 781-395-2922
  • Fax: 781-393-8905
Mailing address:
  • Phone: 781-395-2922
  • Fax: 781-393-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN E SCOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 781-395-2922