Provider Demographics
NPI:1134191125
Name:PEDIATRIC ASSOCIATES OF GREATER SALEM, INC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF GREATER SALEM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-745-3050
Mailing Address - Street 1:30 TOZER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5510
Mailing Address - Country:US
Mailing Address - Phone:978-745-3050
Mailing Address - Fax:978-744-9594
Practice Address - Street 1:84 HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2727
Practice Address - Country:US
Practice Address - Phone:978-745-3050
Practice Address - Fax:978-744-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty