Skip Navigation

Provider Information for 1609288547

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1609288547

Calendar   Last Updated:  2018-05-21
  Certification Date: 


Name Value
NPI 1609288547
Enumeration Date 2014-05-27
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115
United States

Phone: 617-355-5010 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 208000000X - Pediatrics MA 270620
No 208000000X - Pediatrics RI LP03044