Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2014-06-12
- Last updated
- 2015-05-11
Specialties
Licenses
- License MA
- 23347
Location
- Practice location
- 114 CENTRAL ST
- City
- IPSWICH MA
- Postal code
- 019381952
- Phone
- 978-356-9198
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.