=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568549772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL ASSOCIATES OF SAUGUS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE ROOSEVELT AVENUE SUITE 204 MEDICAL ASSOCIATES OF SAUGUS
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-536-7778
-----------------------------------------------------
Fax | 978-536-2998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE ROOSEVELT AVENUE SUITE 204 MEDICAL ASSOCIATES OF SAUGUS
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-536-7778
-----------------------------------------------------
Fax | 978-536-2998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN V GANDOLFO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 978-536-7778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------