Provider Demographics
NPI:1629477989
Name:CONVENIENT PEDIATRIC CARE GROUP, LLC
Entity Type:Organization
Organization Name:CONVENIENT PEDIATRIC CARE GROUP, LLC
Other - Org Name:711 PEDICARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:ORIANA
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:617-366-6129
Mailing Address - Street 1:209 HARVARD ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5071
Mailing Address - Country:US
Mailing Address - Phone:617-366-6129
Mailing Address - Fax:617-608-5951
Practice Address - Street 1:209 HARVARD ST
Practice Address - Street 2:SUITE 407
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5071
Practice Address - Country:US
Practice Address - Phone:617-366-6129
Practice Address - Fax:617-608-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 156328261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care