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NPI Code Detail

MEDICARE: MIDDLEBORO PEDIATRICS, PC

MEDICARE: MIDDLEBORO PEDIATRICS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1713191OTHERMATUFTS HEALTH CARE GROUP #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861556961
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDDLEBORO PEDIATRICS, PC
Provider Business Mailing Address
First Line : 2 LAKEVILLE BUSINESS PARK
Second Line :
City : LAKEVILLE
State : MA
Zip : 02347-1236
Country : US
Telephone Number : 508-947-0630
Fax Number : 508-947-0639
Provider Business Practice Location Address
First Line : 2 LAKEVILLE BUSINESS PARK
Second Line :
City : LAKEVILLE
State : MA
Zip : 02347-1236
Country : US
Telephone Number : 508-947-0630
Fax Number : 508-947-0639
Authorized Official
Title or Position : PRESIDENT
Name : DR. NEAL GERALD BORNSTEIN
Credential : M.D.
Telephone Number : 508-947-0630
Provider Enumeration Date : 12/21/2006
Last Update Date : 10/27/2011

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