Healthcare Provider Details

I. General information

NPI: 1700964590
Provider Name (Legal Business Name): CHESTNUT HILL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOYLSTON ST SUITE 112
CHESTNUT HILL MA
02467-1715
US

IV. Provider business mailing address

25 BOYLSTON ST SUITE 112
CHESTNUT HILL MA
02467
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-2541
  • Fax:
Mailing address:
  • Phone: 617-277-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PATRICIO F VIVES
Title or Position: OWNER
Credential: MD
Phone: 617-277-2541