Provider Demographics
NPI:1205231339
Name:DOREEN KAROLL, MD
Entity Type:Organization
Organization Name:DOREEN KAROLL, MD
Other - Org Name:BOSTON DEVELOPMENTAL PEDIATRICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-549-7377
Mailing Address - Street 1:32 SOUTH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3555
Mailing Address - Country:US
Mailing Address - Phone:781-320-9680
Mailing Address - Fax:781-780-5688
Practice Address - Street 1:32 SOUTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3555
Practice Address - Country:US
Practice Address - Phone:781-320-9680
Practice Address - Fax:781-780-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA737652080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110051703AMedicaid
MAJ31710OtherBCBSMA