Healthcare Provider Details

I. General information

NPI: 1497187223
Provider Name (Legal Business Name): BOSTON CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FL 5 RESPIRATORY DISEASES
BOSTON MA
02115-5711
US

IV. Provider business mailing address

333 LONGWOOD AVE FL 5 RESPIRATORY DISEASES
BOSTON MA
02115-5711
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number254487
License Number StateMA

VIII. Authorized Official

Name: MRS. DONNA GIROMINI
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 617-355-6105