Healthcare Provider Details

I. General information

NPI: 1730202367
Provider Name (Legal Business Name): PIONEER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARADISE RD
SWAMPSCOTT MA
01907-1335
US

IV. Provider business mailing address

505 PARADISE RD
SWAMPSCOTT MA
01907-1335
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-9449
  • Fax: 978-741-3150
Mailing address:
  • Phone: 978-745-9449
  • Fax: 978-741-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9075740
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
IdentifierM17693
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE SHIELD GROUP NUMBER

VIII. Authorized Official

Name: DR. MARK J MESSENGER
Title or Position: OWNER PHYSICIAN
Credential: M.D.
Phone: 978-745-9449