Provider Demographics
NPI:1598850281
Name:PEDIATRICS WEST, PC
Entity Type:Organization
Organization Name:PEDIATRICS WEST, PC
Other - Org Name:ALLERGY WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-577-0437
Mailing Address - Street 1:133 LITTLETON ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3198
Mailing Address - Country:US
Mailing Address - Phone:978-577-0437
Mailing Address - Fax:978-692-9904
Practice Address - Street 1:133 LITTLETON ROAD
Practice Address - Street 2:STE 101
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3198
Practice Address - Country:US
Practice Address - Phone:978-577-0437
Practice Address - Fax:978-692-9904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRICS WEST, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9751483Medicaid
MA9751483Medicaid