Healthcare Provider Details

I. General information

NPI: 1700191814
Provider Name (Legal Business Name): CHILDRENS HOSPITAL BOSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

591 VFW PKWY HANCOCK VILLAGE ,298 INDEPENDENCE DRIVE,CHESTNUT HILL
CHESTNUT HILL MA
02467-3620
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JANET SOUL
Title or Position: ASSISTANT PROFESSOR OF NEUROLOGY
Credential: MD,CM, FRCPC
Phone: 617-355-8994