Provider Demographics
NPI:1164436986
Name:LENNON, ANNE IREYS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:IREYS
Last Name:LENNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BILLINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-773-5400
Mailing Address - Fax:617-773-5420
Practice Address - Street 1:54 BILLINGS ROAD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-773-5400
Practice Address - Fax:617-773-5420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0100340Medicaid
MA0100340Medicaid