Provider Demographics
NPI:1861479115
Name:CHABOT, WENDY A (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:CHABOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8239
Mailing Address - Fax:
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:HARVARD VANGUARD MEDICAL ASSOC, PEDIATRIC URGENT CARE
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5230
Practice Address - Fax:781-431-5518
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2013-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA57371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-2817581OtherCONSOLIDATED
MA04-2817851OtherNORTHEAST HEALTH DIRECT
MA04-2817581OtherUNICARE/GIC
MA057371OtherCONNECTICARE
MA765496OtherTUFTS
MA04-2817581OtherNORTH AMERICAN PREFERRED
MA3399802OtherAETNA
MAJ06605OtherBCBSMA
MA3020720Medicaid
MD04-2817581OtherPIONEER PPO
MA04-2817581OtherPLAN VISTA
MA24863OtherHEALTH NEW ENGLAND
MA782963010OtherCIGNA
MA000000008062OtherBMC
MA04-2817581OtherGREAT-WEST
MA04-2817581OtherPRIVATE HEALTHCARE SYSTEM
MA202153OtherHARVARD PILGRIM
MA765496OtherTUFTS