Healthcare Provider Details

I. General information

NPI: 1679221972
Provider Name (Legal Business Name): CAROLINE ABIGAIL TEMPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE ABIGAIL TEMPLE

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE. MENINO 4
BOSTON MA
02118
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4511
  • Fax:
Mailing address:
  • Phone: 617-414-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1026534
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: