Provider Demographics
NPI:1427377910
Name:PENTA, DOUGLAS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ANTHONY
Last Name:PENTA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:200 HARVARD MILL SQ
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3238
Mailing Address - Country:US
Mailing Address - Phone:781-876-8200
Mailing Address - Fax:781-876-8383
Practice Address - Street 1:200 HARVARD MILL SQ
Practice Address - Street 2:SUITE 330
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3238
Practice Address - Country:US
Practice Address - Phone:781-876-8200
Practice Address - Fax:781-876-8383
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology