Healthcare Provider Details

I. General information

NPI: 1487681912
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL RADIOLOGY FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE DEPARTMENT OF RADIOLOGY
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE DEPARTMENT OF RADIOLOGY
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-8382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TINA POUSSAINT
Title or Position: RADIOLOGIST IN CHIEF
Credential:
Phone: 617-355-6450