Healthcare Provider Details

I. General information

NPI: 1861815656
Provider Name (Legal Business Name): NORTHEAST ALLERGY ASTHMA & IMMUNOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 BOSTON POST ROAD
SUDBURY MA
01776
US

IV. Provider business mailing address

79 ERDMAN WAY SUITE 101
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-537-4805
  • Fax: 978-261-5637
Mailing address:
  • Phone: 978-537-4805
  • Fax: 978-537-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN E. SCOTT
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 978-537-4805