Individual
MRS. MARY E ODEGAARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 GROSSMAN DR, FAMILY MEDICINE, BRAINTREE, MA 02184-4997
(781) 849-2560
(781) 849-2529
Mailing address
111 GROSSMAN DR, FAMILY MEDICINE, BRAINTREE, MA 02184-4997
(781) 849-2560
(781) 849-2529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81548
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080078724
RR MEDICARE
—
01
—
081548
TUFTS
—
05
—
3155102
—
MA
01
—
3552899
CIGNA
—
01
—
70989
HPHC
MA
01
—
ODJ16519
BCBS
MA
Enumeration date
11/03/2005
Last updated
10/23/2020
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