Provider Demographics
NPI:1649248501
Name:VILLAGE PEDIATRICS, LLC
Entity type:Organization
Organization Name:VILLAGE PEDIATRICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-894-8577
Mailing Address - Street 1:ONE PEARL STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2865
Mailing Address - Country:US
Mailing Address - Phone:508-894-8577
Mailing Address - Fax:508-894-8578
Practice Address - Street 1:ONE PEARL STREET
Practice Address - Street 2:SUITE 2000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2865
Practice Address - Country:US
Practice Address - Phone:508-894-8577
Practice Address - Fax:508-894-8578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9782877Medicaid
MA9782877Medicaid