Provider Demographics
NPI:1073501649
Name:FRANK X. PEDLOW JR, MD PC
Entity Type:Organization
Organization Name:FRANK X. PEDLOW JR, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:X
Authorized Official - Last Name:PEDLOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:617-227-9300
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0086
Mailing Address - Country:US
Mailing Address - Phone:781-749-9071
Mailing Address - Fax:781-749-2133
Practice Address - Street 1:30 LANCASTER ST
Practice Address - Street 2:2ND FLR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1704
Practice Address - Country:US
Practice Address - Phone:617-227-9300
Practice Address - Fax:617-227-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79694207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA729566OtherTUFTS
MAF82731OtherHPHC
MA9728236Medicaid
MAM18198OtherBCBS MA
MAF82731Medicare UPIN
MAF82731OtherHPHC