Provider Demographics
NPI:1649269135
Name:ESSEX MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:ESSEX MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANI
Authorized Official - Middle Name:SREE
Authorized Official - Last Name:REDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-725-3636
Mailing Address - Street 1:4 WORTHEN PL
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:978-327-6827
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:978-725-3636
Practice Address - Fax:978-327-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154422261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA28560Medicaid
MA3181235Medicaid
MA3181235Medicaid