Healthcare Provider Details

I. General information

NPI: 1649248501
Provider Name (Legal Business Name): VILLAGE PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE PEARL STREET SUITE 2000
BROCKTON MA
02301-2865
US

IV. Provider business mailing address

ONE PEARL STREET SUITE 2000
BROCKTON MA
02301-2865
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-8577
  • Fax: 508-894-8578
Mailing address:
  • Phone: 508-894-8577
  • Fax: 508-894-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID M HOWELL
Title or Position: OWNER
Credential: M.D.
Phone: 508-894-8577