MEDICARE: JANICE E CROGNALE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	152326	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316048861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE E CROGNALE M.D.

Provider Business Mailing Address
First Line	:	205 WILLOW ST
Second Line	:	LAHEY HEALTH PRIMARY CARE, HAMILTON-WENHAM
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2255
Country	:	US
Telephone Number	:	978-468-7346
Fax Number	:	978-468-6628

Provider Business Practice Location Address
First Line	:	205 WILLOW ST
Second Line	:	LAHEY HEALTH PRIMARY CARE, HAMILTON-WENHAM
City	:	SOUTH HAMILTON
State	:	MA
Zip	:	01982-2255
Country	:	US
Telephone Number	:	978-468-7346
Fax Number	:	978-468-6628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/17/2015

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205 WILLOW ST STE IB
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