Healthcare Provider Details

I. General information

NPI: 1811028343
Provider Name (Legal Business Name): JEHANNA PEERZADA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE CHILDREN'S HOSPITAL BOSTON, EMERGENCY MEDICINE DIVISION
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE CHILDREN'S HOSPITAL BOSTON, EMERGENCY MEDICINE DIVISION
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6624
  • Fax:
Mailing address:
  • Phone: 617-355-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209673
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: