Healthcare Provider Details

I. General information

NPI: 1568882918
Provider Name (Legal Business Name): WALDEN POND PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THOREAU ST
CONCORD MA
01742-2443
US

IV. Provider business mailing address

101 THOREAU ST
CONCORD MA
01742-2443
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-9401
  • Fax: 978-371-8810
Mailing address:
  • Phone: 978-369-9401
  • Fax: 978-371-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number251313
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ESHITA BAKSHI
Title or Position: PEDIATRICIAN
Credential: D.O.
Phone: 857-225-6636