Provider Demographics
NPI:1134757750
Name:WAYLAND PEDIATRICS LLC
Entity type:Organization
Organization Name:WAYLAND PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-358-2918
Mailing Address - Street 1:73 PELHAM ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-2625
Mailing Address - Country:US
Mailing Address - Phone:508-358-2918
Mailing Address - Fax:508-358-6054
Practice Address - Street 1:73 PELHAM ISLAND RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-2625
Practice Address - Country:US
Practice Address - Phone:508-358-2918
Practice Address - Fax:508-358-6054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYLAND PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty