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General NPI Number Information
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NPI Number | 1679575401
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF MEDFORD
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 101 MAIN ST SUITE 201
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City | MEDFORD
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State | MA
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Zip | 02155-4540
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Country | US
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Telephone | 781-396-1288
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Fax | 781-391-1989
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Provider Business Mailing Address
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Address Line | 101 MAIN ST SUITE 201
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City | MEDFORD
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State | MA
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Zip | 02155-4540
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Country | US
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Telephone | 781-396-1288
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Fax | 781-391-1989
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LISA D
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Credential |
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Telephone | 781-396-1288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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