Provider Demographics
NPI:1669669636
Name:MILL RIVER PEDIATRICS
Entity Type:Organization
Organization Name:MILL RIVER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-884-5600
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:508-884-5600
Mailing Address - Fax:508-822-5800
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-884-5600
Practice Address - Fax:508-822-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9712241Medicaid