Provider Demographics
NPI:1659328342
Name:SPLAINE, EDWARD F JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:SPLAINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODHOLM RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1041
Mailing Address - Country:US
Mailing Address - Phone:978-283-1630
Mailing Address - Fax:
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:STE 1600
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6141
Practice Address - Country:US
Practice Address - Phone:978-921-1210
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28967261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center