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General NPI Number Information
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NPI Number | 1710194410
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Entity Type | Organization
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Legal Business Name | PATRIOT PEDIATRICS
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 74 LOOMIS ST
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City | BEDFORD
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State | MA
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Zip | 01730-2248
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Country | US
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Telephone | 781-674-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 74 LOOMIS ST
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City | BEDFORD
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State | MA
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Zip | 01730-2248
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Country | US
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Telephone | 781-674-2900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FRANCINE HENNESSEY
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Credential | M.D.
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Telephone | 781-674-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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