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General NPI Number Information
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NPI Number | 1477752335
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Entity Type | Organization
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Legal Business Name | DARTMOUTH PEDIATRICS
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 49 STATE RD PEQUOT BLDG #201
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747-3322
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Country | US
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Telephone | 508-961-1644
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Fax | 508-984-5893
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Provider Business Mailing Address
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Address Line | 49 STATE RD PEQUOT BLDG #201
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747-3322
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Country | US
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Telephone | 508-961-1644
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Fax | 508-984-5893
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MOHSEN ALI ELHADDAD
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Credential | MD
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Telephone | 508-961-1644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 77609
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License Number State | MA
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