Provider Demographics
NPI:1780249292
Name:DEVELOPMENTAL PEDIATRICS OF GREATER BOSTON, LLC
Entity type:Organization
Organization Name:DEVELOPMENTAL PEDIATRICS OF GREATER BOSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:B
Authorized Official - Last Name:GERSHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-856-6530
Mailing Address - Street 1:100 HIGH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1100
Mailing Address - Country:US
Mailing Address - Phone:781-856-6530
Mailing Address - Fax:781-449-0580
Practice Address - Street 1:100 HIGH ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1100
Practice Address - Country:US
Practice Address - Phone:781-856-6530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty