Provider Demographics
NPI:1013986694
Name:MILTON PEDIATRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:MILTON PEDIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NILOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-356-6200
Mailing Address - Street 1:340 WOOD ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-356-6200
Mailing Address - Fax:781-356-6299
Practice Address - Street 1:340 WOOD ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-356-6200
Practice Address - Fax:781-356-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA056054OtherTUFTS
MA9738444Medicaid
MAM18902OtherBLUE SHIELD