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General NPI Number Information
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NPI Number | 1821127556
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Entity Type | Organization
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Legal Business Name | NEWBUEYPORT PEDIATRICS,INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21 HIGHLAND AVE
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3872
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Country | US
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Telephone | 978-462-7108
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Fax | 978-499-0471
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Provider Business Mailing Address
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Address Line | 21 HIGHLAND AVE
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City | NEWBURYPORT
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State | MA
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Zip | 01950-3872
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Country | US
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Telephone | 978-462-7108
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Fax | 978-499-0471
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALICE VIVIAN MERKREBS
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Credential | M.D.
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Telephone | 978-462-7108
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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 | 160996
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License Number State | MA
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