Provider Demographics
NPI:1841234531
Name:CHILDREN'S HOSPITAL BOSTON
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN-IN-CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLEISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-355-6000
Mailing Address - Street 1:CHILDRENS HOSPITAL BOSTON
Mailing Address - Street 2:300 LONGWOOD AVENUE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-4972
Mailing Address - Fax:617-730-0208
Practice Address - Street 1:CHILDRENS HOSPITAL BOSTON
Practice Address - Street 2:300 LONGWOOD AVENUE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-4972
Practice Address - Fax:617-730-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111045281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren