Provider Demographics
NPI:1568549772
Name:MEDICAL ASSOCIATES OF SAUGUS PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF SAUGUS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:GANDOLFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-536-7778
Mailing Address - Street 1:ONE ROOSEVELT AVENUE SUITE 204
Mailing Address - Street 2:MEDICAL ASSOCIATES OF SAUGUS
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-536-7778
Mailing Address - Fax:978-536-2998
Practice Address - Street 1:ONE ROOSEVELT AVENUE SUITE 204
Practice Address - Street 2:MEDICAL ASSOCIATES OF SAUGUS
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-536-7778
Practice Address - Fax:978-536-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9701133Medicaid
685660OtherTOFTS HEALTH PLANS MA
M17573OtherBLUE SHIELD OF MA
MA9701133Medicaid