Provider Demographics
NPI:1932214178
Name:DIDDEE, ANU (MD)
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:
Last Name:DIDDEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL ROAD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:978-538-4300
Mailing Address - Fax:978-538-4711
Practice Address - Street 1:1 ESSEX CENTER DRIVE
Practice Address - Street 2:LAHEY NORTHSHORE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-4300
Practice Address - Fax:978-538-4711
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13582207R00000X
MA243582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00212301OtherMEDICARE PTAN
NH30207013Medicaid
MA110089615AMedicaid
MA110089615AMedicaid
MA000212303Medicare PIN
NH30207013Medicaid