Healthcare Provider Details

I. General information

NPI: 1053387795
Provider Name (Legal Business Name): JOSEPH L PENNACCHIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MONTVALE AVE HEMATOLOGY & ONCOLOGY CENTER
STONEHAM MA
02180-2445
US

IV. Provider business mailing address

41 MONTVALE AVE HEMATOLOGY & ONCOLOGY CENTER
STONEHAM MA
02180-2445
US

V. Phone/Fax

Practice location:
  • Phone: 781-224-5810
  • Fax: 781-224-5813
Mailing address:
  • Phone: 781-224-5810
  • Fax: 781-224-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number42715
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: