Healthcare Provider Details

I. General information

NPI: 1306178702
Provider Name (Legal Business Name): CARDONE REPRODUCTIVE MEDICINE & INFERTILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MAIN ST SUITE 150
STONEHAM MA
02180-3335
US

IV. Provider business mailing address

2 MAIN ST SUITE 150
STONEHAM MA
02180-3335
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-9600
  • Fax: 781-438-9601
Mailing address:
  • Phone: 781-438-9600
  • Fax: 781-438-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number56751
License Number StateMA

VIII. Authorized Official

Name: GAIL K HENDRICKSON
Title or Position: COO/PRACTICE ADMINISTRATOR
Credential:
Phone: 781-438-9600