Healthcare Provider Details

I. General information

NPI: 1124150347
Provider Name (Legal Business Name): CHILDREN'S GARDEN PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 CONCORD AVE
CAMBRIDGE MA
02138-1048
US

IV. Provider business mailing address

799 CONCORD AVE
CAMBRIDGE MA
02138-1048
US

V. Phone/Fax

Practice location:
  • Phone: 617-441-9276
  • Fax: 617-491-5222
Mailing address:
  • Phone: 617-441-9276
  • Fax: 617-491-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number213874
License Number StateMA

VIII. Authorized Official

Name: DR. DEBORAH EILEEN JAMES
Title or Position: PHYSICIAN PRACTICE OWNER
Credential: M.D.
Phone: 617-441-9276