Healthcare Provider Details

I. General information

NPI: 1508926007
Provider Name (Legal Business Name): CHILD HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MILLBURY ST
AUBURN MA
01501
US

IV. Provider business mailing address

105 MILLBURY ST
AUBURN MA
01501
US

V. Phone/Fax

Practice location:
  • Phone: 508-832-9691
  • Fax: 508-832-7670
Mailing address:
  • Phone: 508-832-9691
  • Fax: 508-832-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9759425
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MADELINE B MORRIS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 508-832-9691