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General NPI Number Information
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NPI Number | 1649479684
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Entity Type | Organization
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Legal Business Name | KIDS DR. PC
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 12 MAIN ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-2410
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Country | US
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Telephone | 978-682-3300
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Fax | 978-682-3363
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Provider Business Mailing Address
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Address Line | 12 MAIN ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-2410
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Country | US
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Telephone | 978-682-3300
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Fax | 978-682-3363
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. ANN R MCGRAVEY-RICCIO
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Credential | MD
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Telephone | 978-682-3300
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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 | 049953
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License Number State | MA
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