Provider Demographics
NPI:1932792355
Name:LEXINGTON PEDIATRICS, LLC
Entity Type:Organization
Organization Name:LEXINGTON PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL AND OPERATIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-TATAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-862-4110
Mailing Address - Street 1:57 BEDFORD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4550
Mailing Address - Country:US
Mailing Address - Phone:781-862-4110
Mailing Address - Fax:781-863-2007
Practice Address - Street 1:57 BEDFORD ST STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4550
Practice Address - Country:US
Practice Address - Phone:781-862-4110
Practice Address - Fax:781-863-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty