Provider Demographics
NPI:1013015791
Name:WAKEFIELD PEDIATRICS, LLC
Entity Type:Organization
Organization Name:WAKEFIELD PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-783-8008
Mailing Address - Street 1:46 HOLLEY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3325
Mailing Address - Country:US
Mailing Address - Phone:401-783-8008
Mailing Address - Fax:401-783-8156
Practice Address - Street 1:46 HOLLEY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3325
Practice Address - Country:US
Practice Address - Phone:401-783-8008
Practice Address - Fax:401-783-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty