NPIMap

Organization Active NPI

Pediatric Associates of Medford

  • Specialist
  • Medford, MA
National Provider Identifier
1679575401
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PEDIATRIC ASSOCIATES OF MEDFORD
Practice address
101 Main St
Suite 201
Medford, MA 02155-4540
Phone
(781) 396-1288
Fax
(781) 391-1989
NPI assigned
Aug 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa D
Title
Practice Manager
Phone
(781) 396-1288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

101 Main St
Suite 201
Medford, MA 02155-4540

Mailing address

101 Main St
Suite 201
Medford, MA 02155-4540
Phone (781) 396-1288

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Assoc of Medford2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1679575401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "address_2": "SUITE 201",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554540",
            "telephone_number": "781-396-1288",
            "fax_number": "781-391-1989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST",
            "address_2": "SUITE 201",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021554540",
            "telephone_number": "781-396-1288",
            "fax_number": "781-391-1989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF MEDFORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "D",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "781-396-1288"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.