| North Shore Neurology & Emg Llc | |
|
83 Herrick Street Suite 1001 Beverly MA 01915 | |
| (978) 921-1900 | |
| (978) 921-6694 |
| Full Name | North Shore Neurology & Emg Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 83 Herrick Street, Beverly, Massachusetts |
| Authorized Official Name and Position | Timothy Raymond Kelliher (PRESIDENT) |
| Authorized Official Contact | 9789222226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Shore Neurology & Emg Llc 83 Herrick St Suite 1001 Beverly MA 01915-2757 Ph: (978) 922-2226 | North Shore Neurology & Emg Llc 83 Herrick Street Suite 1001 Beverly MA 01915 Ph: (978) 921-1900 |
| NPI Number | 1982996039 |
|---|---|
| Provider Enumeration Date | 05/09/2011 |
| Last Update Date | 10/16/2023 |
| Certification Date | 10/16/2023 |
| Medicare PECOS PAC ID | 4183886609 |
|---|---|
| Medicare Enrollment ID | O20120430000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982996039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 75613 (Massachusetts) | Primary |
| Provider Name | Timothy R Kelliher |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043314198 PECOS PAC ID: 4688682750 Enrollment ID: I20060331000053 |
| Provider Name | Melissa A Diggin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851361786 PECOS PAC ID: 6002993342 Enrollment ID: I20080410000275 |
| Provider Name | Ilya V Bogorad |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518116250 PECOS PAC ID: 3072639145 Enrollment ID: I20100927000117 |
| Provider Name | Priya Shastri |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023216827 PECOS PAC ID: 4284805458 Enrollment ID: I20110920000041 |
| Provider Name | Louis A Tramontozzi |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245401678 PECOS PAC ID: 2163698077 Enrollment ID: I20121101000614 |
| Provider Name | Eric H Grover |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508170820 PECOS PAC ID: 1456590702 Enrollment ID: I20210125000250 |
| Provider Name | Jillian Pearl Annese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285238246 PECOS PAC ID: 8224437066 Enrollment ID: I20210526003303 |
| Provider Name | Bethany Grace Avila Otte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194265744 PECOS PAC ID: 3577803816 Enrollment ID: I20221205000309 |
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Dba Scott R. Olson Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Cummings Center Suite 5350, North Shore Psychiatry Center, Beverly, MA 01915 Phone: 978-922-8600 Fax: 978-922-8601 | |
Clinical Solutions, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 100 Cummings Ctr, Suite 457 -j, Beverly, MA 01915 Phone: 617-955-9228 | |
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