Provider Demographics
NPI:1700964590
Name:CHESTNUT HILL PEDIATRICS
Entity Type:Organization
Organization Name:CHESTNUT HILL PEDIATRICS
Other - Org Name:PATRICIO VIVES MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:VIVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-277-2541
Mailing Address - Street 1:25 BOYLSTON ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467
Mailing Address - Country:US
Mailing Address - Phone:617-277-2541
Mailing Address - Fax:
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:617-277-2541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty