Healthcare Provider Details

I. General information

NPI: 1013139336
Provider Name (Legal Business Name): PEDIATRIC PULMONARY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN STREET
BRIGHTON MA
02135
US

IV. Provider business mailing address

PO BOX 35825
BRIGHTON, MA MA
02135
US

V. Phone/Fax

Practice location:
  • Phone: 617-783-0475
  • Fax: 617-779-1239
Mailing address:
  • Phone: 617-783-0475
  • Fax: 617-779-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA S KHARASCH
Title or Position: PRESIDENT
Credential: MD
Phone: 617-783-0475