Provider Demographics
NPI:1710076542
Name:NEPONSET VALLEY PEDIATRICS PC
Entity Type:Organization
Organization Name:NEPONSET VALLEY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-784-0403
Mailing Address - Street 1:450 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-784-0403
Mailing Address - Fax:781-784-0407
Practice Address - Street 1:450 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067
Practice Address - Country:US
Practice Address - Phone:781-784-0403
Practice Address - Fax:781-784-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200944OtherHARVARD PILGRIM
MA9786635Medicaid
1240551OtherUNITED NC
07930OtherTUFTS
MAJ14677OtherBLUE CROSS BLUE SHIELD
0473852OtherAETNA