Provider Demographics
NPI:1710194410
Name:PATRIOT PEDIATRICS
Entity Type:Organization
Organization Name:PATRIOT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-674-2900
Mailing Address - Street 1:74 LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2248
Mailing Address - Country:US
Mailing Address - Phone:781-674-2900
Mailing Address - Fax:
Practice Address - Street 1:74 LOOMIS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2248
Practice Address - Country:US
Practice Address - Phone:781-674-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA150518OtherTUFTS HEALTH PLAN
MA718556OtherTUFTS HEALTH PLAN
MA070324OtherTUFTS HEALTH PLAN
MA1578700OtherTUFTS HEALTH PLAN