Provider Demographics
NPI:1568882918
Name:WALDEN POND PEDIATRICS, PC
Entity Type:Organization
Organization Name:WALDEN POND PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ESHITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:857-225-6636
Mailing Address - Street 1:101 THOREAU ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2443
Mailing Address - Country:US
Mailing Address - Phone:978-369-9401
Mailing Address - Fax:978-371-8810
Practice Address - Street 1:101 THOREAU ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2443
Practice Address - Country:US
Practice Address - Phone:978-369-9401
Practice Address - Fax:978-371-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty