PEDIATRIC ASSOCIATES OF MEDFORD NPI 1679575401

NPI Information

PEDIATRIC ASSOCIATES OF MEDFORD is a specialist in Medford, MA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. PEDIATRIC ASSOCIATES OF MEDFORD NPI is 1679575401. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

101 MAIN ST
SUITE 201
MEDFORD, MA
ZIP 02155-540
Phone: (781) 396-1288
Fax: (781) 391-1989

The provider's authorized official is Lisa D .
The authorized official title is Practice Manager and has the following contact phone number (781) 396-1288.

The CLIA number assigned to this NPI record is 22D0077616 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2005 and was last updated on 5/13/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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