Provider Demographics
NPI:1790841591
Name:WILMINGTON PEDIATRICS, INC.
Entity Type:Organization
Organization Name:WILMINGTON PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAND
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-988-6209
Mailing Address - Street 1:500 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1200
Mailing Address - Country:US
Mailing Address - Phone:978-988-6209
Mailing Address - Fax:978-988-6139
Practice Address - Street 1:500 SALEM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1200
Practice Address - Country:US
Practice Address - Phone:978-988-6209
Practice Address - Fax:978-988-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600594OtherTUFTS GROUP NUMBER
MA9765387Medicaid
MDM15347OtherBLUE CROSS GROUP NUMBER