Provider Demographics
NPI: | 1457306664 |
---|---|
Name: | CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC |
Entity Type: | Organization |
Organization Name: | CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF, DEPARTMENT OF PEDIATRICS |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WENDY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHUNG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 617-355-6000 |
Mailing Address - Street 1: | PO BOX 4161 |
Mailing Address - Street 2: | |
Mailing Address - City: | WOBURN |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01888-4161 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 844-769-7804 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 300 LONGWOOD AVE |
Practice Address - Street 2: | |
Practice Address - City: | BOSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02115-5737 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-355-6000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-24 |
Last Update Date: | 2023-10-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | Group - Multi-Specialty |
No | 2080P0204X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Multi-Specialty |
No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 9731750 | Medicaid | |
MA | M10004 | Other | MA BLUE CROSS/BLUE SHIELD |
MA | 699102 | Other | TUFTS HEALTH PLAN |
MA | 602545 | Other | HARVARD PILGRIM HEALTH CA |
M21406 | Medicare PIN |