Provider Demographics
NPI:1417965617
Name:PEDIATRICS INC
Entity Type:Organization
Organization Name:PEDIATRICS INC
Other - Org Name:STONEHAM PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AESCHLIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FAAP
Authorized Official - Phone:781-438-7330
Mailing Address - Street 1:577 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-438-7330
Mailing Address - Fax:781-279-4046
Practice Address - Street 1:577 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-438-7330
Practice Address - Fax:781-279-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9768904Medicaid
MA9768904Medicaid