Provider Demographics
NPI:1982887873
Name:JOSEPH L PENNACCHIO, MD
Entity type:Organization
Organization Name:JOSEPH L PENNACCHIO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENNACCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-662-6404
Mailing Address - Street 1:50 TREMONT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2721
Mailing Address - Country:US
Mailing Address - Phone:781-662-6404
Mailing Address - Fax:781-665-0658
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-662-6404
Practice Address - Fax:781-665-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42715207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0194662Medicaid
MA0194662Medicaid
MAB72551Medicare UPIN