NPIMap

Organization Active NPI

Pentucket Medical Associates LLC

  • Clinical Medical Laboratory
  • Haverhill, MA
National Provider Identifier
1710959861
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
2469 Issued in MA
Legal business name
PENTUCKET MEDICAL ASSOCIATES LLC
Practice address
1 Parkway
Haverhill, MA 01830-6278
Phone
(978) 469-3203
Fax
(978) 469-5378
NPI assigned
Feb 3, 2006
Last updated
Jan 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Authorized official

Name
Thomas Fazio
Title
Managing Partner
Phone
(978) 469-5586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 2469 MA Primary

Addresses

Primary practice location

1 Parkway
Haverhill, MA 01830-6278

Mailing address

1 Parkway
Haverhill, MA 01830-6278
Phone (978) 469-3203

Other identifiers 4

IdentifierTypeStateIssuer
0034962OtherMANEIGHBORHOOD HEALTH PLAN
807895OtherMATUFTS HEALTH PLAN
0800147MedicaidMA
018466OtherMAMASS. BLUE CROSS

National Provider Directory

National Provider Directory

Locations

161 W Main St
Georgetown, MA 01833
Phone (978) 352-8375

87 Jackson St
Methuen, MA 01844
Phone (978) 208-4756

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1710959861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306278",
            "telephone_number": "978-469-3203",
            "fax_number": "978-469-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARKWAY",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018306278",
            "telephone_number": "978-469-3203",
            "fax_number": "978-469-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTUCKET MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-03",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "FAZIO",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "978-469-5586"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MA",
            "license": "2469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0034962",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "807895",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800147",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASS. BLUE CROSS",
            "identifier": "018466",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Haverhill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2008; 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.