Provider Demographics
NPI:1245264456
Name:METROWEST PEDIATRICS PC
Entity type:Organization
Organization Name:METROWEST PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-620-6615
Mailing Address - Street 1:33 EDGELL RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4833
Mailing Address - Country:US
Mailing Address - Phone:508-620-6615
Mailing Address - Fax:508-879-1597
Practice Address - Street 1:33 EDGELL RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-620-6615
Practice Address - Fax:508-879-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17360OtherBS
MA688580OtherTUFTS
MA9786864Medicaid