Provider Demographics
NPI:1821336827
Name:DEDHAM MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:DEDHAM MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING REP
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-278-5511
Mailing Address - Street 1:1 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5599
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-329-8470
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-329-8470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDHAM MEDICAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty