Provider Demographics
NPI:1417946161
Name:MEDICAL ASSOCIATES PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:OHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-514-6300
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-514-6300
Mailing Address - Fax:978-514-6321
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-514-6300
Practice Address - Fax:978-514-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9782958Medicaid
MA9782958Medicaid