Provider Demographics
NPI:1922113711
Name:DWYER, PATRICIA S (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:DWYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ENDICOTT ST
Mailing Address - Street 2:SUITE LL05
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-739-7709
Mailing Address - Fax:978-739-7736
Practice Address - Street 1:104 ENDICOTT ST
Practice Address - Street 2:SUITE LL05
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-739-7709
Practice Address - Fax:978-739-7736
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008734207P00000X
NH13487207P00000X
MA253474207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2137712Medicaid
P00443538OtherRAILROAD MEDICARE
NH04Y012069NH01OtherANTHEM
AA95156OtherHARVARD PILGRIM
MA110076042AMedicaid
NH30226011Medicaid
NHP00869040OtherRAILROAD MEDICARE
NH7487855OtherAETNA
MA2137712Medicaid
NH000256402Medicare PIN