Provider Demographics
NPI:1669667234
Name:ANNA PETROPOULOS WEISSLEDER, MD, INC
Entity Type:Organization
Organization Name:ANNA PETROPOULOS WEISSLEDER, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROPOULOS WEISSLEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-739-9500
Mailing Address - Street 1:80 LINDALL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2135
Mailing Address - Country:US
Mailing Address - Phone:978-739-9500
Mailing Address - Fax:978-739-9502
Practice Address - Street 1:80 LINDALL ST STE 2
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2135
Practice Address - Country:US
Practice Address - Phone:978-739-9500
Practice Address - Fax:978-739-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA159221Medicaid
MAAP2505Medicare PIN
MAH44169Medicare UPIN
MAA32761Medicare PIN