Provider Demographics
NPI:1972716793
Name:TOWN OF WAKEFIELD BOARD OF HEALTH
Entity Type:Organization
Organization Name:TOWN OF WAKEFIELD BOARD OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-246-6375
Mailing Address - Street 1:ONE LAFAYETTE STREET
Mailing Address - Street 2:ROOM 29 2ND FLLOR
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-246-6375
Mailing Address - Fax:781-224-5018
Practice Address - Street 1:ONE LAFAYETTE STREET
Practice Address - Street 2:ROOM 29 2ND FLLOR
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-246-6375
Practice Address - Fax:781-224-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11020Medicare ID - Type Unspecified