Provider Demographics
NPI:1629144555
Name:HYDE PARK PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:HYDE PARK PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SAX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-361-1470
Mailing Address - Street 1:695 TRUMAN HWY
Mailing Address - Street 2:SUITE #203
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3552
Mailing Address - Country:US
Mailing Address - Phone:617-361-1470
Mailing Address - Fax:617-361-9060
Practice Address - Street 1:695 TRUMAN HWY
Practice Address - Street 2:SUITE #203
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3552
Practice Address - Country:US
Practice Address - Phone:617-361-1470
Practice Address - Fax:617-361-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty