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Organization

SANDWICH PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARIANNE SARAH KOENIG MD (OWNER)
(508) 888-8430
Entity
Organization

Contact information

Practice address
449 ROUTE 130, SANDWICH, MA 02563-2339
(508) 888-8430
(508) 888-6673
Mailing address
449 ROUTE 130, SANDWICH, MA 02563-2339
(508) 888-8430
(508) 888-6673

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
50001
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9766006
MA
01
SAM15113
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/14/2007
Last updated
08/22/2020
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