Provider Demographics
NPI:1497901078
Name:CHILDRENS MEDICAL SERVICES
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAPIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-996-3151
Mailing Address - Street 1:49 STATE RD
Mailing Address - Street 2:NAUSET BLDGE SUITE 102
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3322
Mailing Address - Country:US
Mailing Address - Phone:508-996-3151
Mailing Address - Fax:
Practice Address - Street 1:49 STATE RD
Practice Address - Street 2:NAUSET BLDGE SUITE 102
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3322
Practice Address - Country:US
Practice Address - Phone:508-996-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty