Provider Demographics
NPI:1386768752
Name:COMMUNITY PEDIATRICS PC
Entity type:Organization
Organization Name:COMMUNITY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:IREYS
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-773-5400
Mailing Address - Street 1:54 BILLINGS RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2302
Mailing Address - Country:US
Mailing Address - Phone:617-773-5400
Mailing Address - Fax:617-773-5420
Practice Address - Street 1:54 BILLINGS RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2302
Practice Address - Country:US
Practice Address - Phone:617-773-5400
Practice Address - Fax:617-773-5420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9702300Medicaid