Organization
MARBLEHEAD PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A GAST D.O. (PRESIDENT)
(781) 631-7800
Entity
Organization
Contact information
Practice address
70 ATLANTIC AVE, MARBLEHEAD, MA 01945-3042
(781) 631-7800
(781) 631-4319
Mailing address
70 ATLANTIC AVE, MARBLEHEAD, MA 01945-3042
(781) 631-7800
(781) 631-4319
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110068239
—
MA
05
—
9718338
—
MA
Enumeration date
01/11/2007
Last updated
08/31/2022
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