Provider Demographics
NPI:1740654599
Name:WORCESTER PEDIATRICS PC
Entity type:Organization
Organization Name:WORCESTER PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL-WREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-363-9530
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:690 NORTH
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-9530
Mailing Address - Fax:508-363-9535
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:690 NORTH
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-9530
Practice Address - Fax:508-363-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty