Healthcare Provider Details

I. General information

NPI: 1679608376
Provider Name (Legal Business Name): POST ROAD PEDIATRICS,LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 BOSTON POST RD
SUDBURY MA
01776-3376
US

IV. Provider business mailing address

616 BOSTON POST RD
SUDBURY MA
01776-3376
US

V. Phone/Fax

Practice location:
  • Phone: 978-443-6005
  • Fax: 978-443-8429
Mailing address:
  • Phone: 978-443-6005
  • Fax: 978-443-8429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number153615
License Number StateMA

VIII. Authorized Official

Name: DR. SANA ASSAF
Title or Position: PARTNER
Credential: M.D.
Phone: 978-443-6005