Provider Demographics
NPI:1548465818
Name:MARVIN H. KENDRICK, MD, PC
Entity type:Organization
Organization Name:MARVIN H. KENDRICK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-7752
Mailing Address - Street 1:131 OLD ROAD TO 9 ACRE COR STE 800
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4162
Mailing Address - Country:US
Mailing Address - Phone:978-369-7752
Mailing Address - Fax:978-369-5706
Practice Address - Street 1:131 OLD ROAD TO 9 ACRE COR STE 800
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4162
Practice Address - Country:US
Practice Address - Phone:978-369-7752
Practice Address - Fax:978-369-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM1290901Medicare PIN