# DEDHAM MEDICAL ASSOC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366442436
- **Authorized official:** MR. RICHARD M RUSSO (CFO)
- **Authorized official phone:** (781) 278-5540

## Contact information

- **Practice address:** 1 LYONS ST, DEDHAM, MA 02026-5599
- **Practice address phone:** (781) 329-1400
- **Practice address fax:** (781) 278-5667
- **Mailing address:** PO BOX 9120, DEDHAM, MA 02027-9120
- **Mailing address phone:** (781) 329-1400
- **Mailing address fax:** (781) 278-5667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | MA | Yes |

## Other

- **Enumeration date:** 07/29/2005
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9766529 | — | MA |
| 05 | — | 9766537 | — | MA |
| 05 | — | 9766545 | — | MA |
| 05 | — | 9766553 | — | MA |
| 05 | — | 9766561 | — | MA |
| 05 | — | 9766588 | — | MA |
| 05 | — | 9766596 | — | MA |
| 05 | — | 9766618 | — | MA |
| 05 | — | 9766626 | — | MA |
| 05 | — | 9766634 | — | MA |