Provider Demographics
NPI:1053387795
Name:PENNACCHIO, JOSEPH L (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:PENNACCHIO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 MONTVALE AVE
Mailing Address - Street 2:HEMATOLOGY & ONCOLOGY CENTER
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2445
Mailing Address - Country:US
Mailing Address - Phone:781-224-5810
Mailing Address - Fax:781-224-5813
Practice Address - Street 1:41 MONTVALE AVE
Practice Address - Street 2:HEMATOLOGY & ONCOLOGY CENTER
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2445
Practice Address - Country:US
Practice Address - Phone:781-224-5810
Practice Address - Fax:781-224-5813
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-01-30
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Provider Licenses
StateLicense IDTaxonomies
MA42715207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0194662Medicaid
MA705660OtherTUFTS
MAA03065OtherBLUE CROSS LEGACY #
MAAA85731OtherHARVARD PILGRIM
MAA03065Medicare PIN