Organization
HARVARD VANGUARD MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE WALLACE (CHEIF EXECUTIVE OFFICER)
(617) 559-8096
Entity
Organization
Contact information
Practice address
2 ESSEX CENTER DR, PEABODY, MA 01960-2902
(617) 559-8096
Mailing address
275 GROVE ST, SUITE 3-300, AUBURNDALE, MA 02466-2272
(617) 559-8096
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207K00000X
Allergy & Immunology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9782834
—
MA
Enumeration date
05/11/2006
Last updated
10/31/2007
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