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Organization
SHAWSHEEN MEDICAL ASSO PC
Active
Organization
SHAWSHEEN MEDICAL ASSO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUETTA TENNEY MD (PRESIDENT OWNER)
(978) 475-8886
Entity
Organization
Contact information
Practice address
28 ANDOVER ST, ANDOVER, MA 01810
(978) 475-8989
(978) 475-8886
Mailing address
28 ANDOVER ST, ANDOVER, MA 01810
(978) 475-8989
(978) 475-8886
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54177
FULLON
—
05
—
9711180
—
MA
01
—
C0193
CIGNA
—
01
—
M17815
BCBS
MA
01
—
SHAW119181
BCBS NH
—
Enumeration date
11/28/2006
Last updated
08/22/2020
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