Provider Demographics
NPI:1508982422
Name:TOWN OF MARBLEHEAD
Entity Type:Organization
Organization Name:TOWN OF MARBLEHEAD
Other - Org Name:BOARD OF HEALTH HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-631-0212
Mailing Address - Street 1:7 WIDGER RD
Mailing Address - Street 2:MARY ALLEY MUNICIPAL BUILDING
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2197
Mailing Address - Country:US
Mailing Address - Phone:781-631-0212
Mailing Address - Fax:781-639-3064
Practice Address - Street 1:7 WIDGER RD
Practice Address - Street 2:MARY ALLEY MUNICIPAL BUILDING
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2197
Practice Address - Country:US
Practice Address - Phone:781-631-0212
Practice Address - Fax:781-639-3064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF MARBLEHEAD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2739OtherMEDICARE EDI SUBMITTER ID
MAY11063Medicare ID - Type Unspecified
MAY11063Medicare PIN
MA2739Medicare ID - Type UnspecifiedEDI SUBMITTER ID