Provider Demographics
NPI:1144262874
Name:CHILDREN'S MEDICAL OFFICE OF NORTH ANDOVER, PC
Entity type:Organization
Organization Name:CHILDREN'S MEDICAL OFFICE OF NORTH ANDOVER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-975-3355
Mailing Address - Street 1:477 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5036
Mailing Address - Country:US
Mailing Address - Phone:978-975-3355
Mailing Address - Fax:
Practice Address - Street 1:477 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5036
Practice Address - Country:US
Practice Address - Phone:978-975-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA97505301OtherNETWORK HEALTH PLAN
MA36117OtherFALLON COMMUNITY HEALTH P
MA717523OtherTUFTS HEALTH PLAN
MA731931OtherUNITED HEALTH CARE
MAM15683OtherBLUE CROSS BLUE SHIELD
MA82573OtherAETNA HEALTH CARE
NH30210526Medicaid
MA9770801Medicaid