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General NPI Number Information
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NPI Number | 1215890421
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Entity Type | Organization
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Legal Business Name | CHRONIC CARE SPECIALISTS OF MA PC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 15 KIRKBRIDE DR
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City | DANVERS
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State | MA
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Zip | 01923-6011
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Country | US
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Telephone | 212-734-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 1999 CEDARBRIDGE AVE STE 1A
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City | LAKEWOOD
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State | NJ
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Zip | 08701-7048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WASEEM GHANNAM
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Credential |
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Telephone | 704-231-4571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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