Healthcare Provider Details

I. General information

NPI: 1447794623
Provider Name (Legal Business Name): BOSTON CHILDRENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

65 MILLER AVE
MILTON MA
02186-4756
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone: 617-698-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD MANDELL
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 617-355-6000