Healthcare Provider Details

I. General information

NPI: 1053927574
Provider Name (Legal Business Name): BOSTON COMMUNITY PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 ALBANY ST STE 200
BOSTON MA
02118-2511
US

IV. Provider business mailing address

527 ALBANY ST STE 200
BOSTON MA
02118-2511
US

V. Phone/Fax

Practice location:
  • Phone: 617-934-6009
  • Fax: 617-934-7102
Mailing address:
  • Phone: 617-934-6009
  • Fax: 617-934-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBYN RISEBERG
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 617-934-6009