Provider Demographics
NPI:1811092000
Name:RIMAWI PEDIATRICS PC
Entity type:Organization
Organization Name:RIMAWI PEDIATRICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIMAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-232-3132
Mailing Address - Street 1:25 WALNUT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-489-5546
Mailing Address - Fax:781-489-5769
Practice Address - Street 1:25 WALNUT ST
Practice Address - Street 2:STE 102
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-489-5546
Practice Address - Fax:781-489-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1600212080P0006X
MA160607208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3198341Medicaid
MA0109070Medicaid
MAA31497Medicare ID - Type UnspecifiedLAMA RIMAWI
MA0109070Medicaid
MA3198341Medicaid