Provider Demographics
NPI:1033694849
Name:BROOKLINE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:BROOKLINE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-478-3457
Mailing Address - Street 1:1180 BEACON ST STE 7A
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3806
Mailing Address - Country:US
Mailing Address - Phone:617-232-2915
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON ST STE 7A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3806
Practice Address - Country:US
Practice Address - Phone:617-232-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty