Provider Demographics
NPI:1912031568
Name:BEVERLY PEDIATRIC ASSOICATES
Entity Type:Organization
Organization Name:BEVERLY PEDIATRIC ASSOICATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-922-3208
Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-3208
Mailing Address - Fax:978-927-7429
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:SUITE 116
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-3208
Practice Address - Fax:978-927-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9779906Medicaid
MA9779906Medicaid