Provider Demographics
NPI:1720028152
Name:UNIVERSAL PEDIATRIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:UNIVERSAL PEDIATRIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-647-4955
Mailing Address - Street 1:218 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1139
Mailing Address - Country:US
Mailing Address - Phone:508-647-4955
Mailing Address - Fax:508-647-4956
Practice Address - Street 1:11 NOD HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-2026
Practice Address - Country:US
Practice Address - Phone:617-230-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39074Medicare UPIN