Basic Information
| Provider Information | |||||||||
| NPI: | 1528261690 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHSHORE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019232033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787771187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 172 LAFAYETTE ST. | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787441386 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DIPIETRO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OUTPATIENT CLINIC | ||||||||
| AuthorizedOfficialTelephone: | 9787441386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.