Provider Demographics
NPI:1699914325
Name:EATON MEDICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:EATON MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:GIBRAN
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:978-973-2740
Mailing Address - Street 1:87 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5044
Mailing Address - Country:US
Mailing Address - Phone:978-208-4756
Mailing Address - Fax:978-685-5950
Practice Address - Street 1:87 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5044
Practice Address - Country:US
Practice Address - Phone:978-208-4756
Practice Address - Fax:978-685-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA13929OtherHARVARD PILGRIM HEALTHCARE
MAJ27682OtherBLUE CROSS BLUE SHIELD
MA2061546Medicaid
MA469196OtherTUFTS HEALTH PLAN
MA469196OtherTUFTS HEALTH PLAN