Provider Demographics
NPI:1013139336
Name:PEDIATRIC PULMONARY SPECIALISTS
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHARASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-783-0475
Mailing Address - Street 1:PO BOX 35825
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON, MA
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-783-0475
Mailing Address - Fax:617-779-1239
Practice Address - Street 1:30 WARREN STREET
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-783-0475
Practice Address - Fax:617-779-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781056Medicaid
MA3055736Medicaid
MA1477553923OtherINDIVIDUAL NPI NUMBER
MA1477553923OtherINDIVIDUAL NPI NUMBER
MAE94315Medicare UPIN