Healthcare Provider Details

I. General information

NPI: 1619009792
Provider Name (Legal Business Name): HIGHLAND PEDIATRICS
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

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1030 PRESIDENT AVE
FALL RIVER MA
02720-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-6833
  • Fax: 508-678-2200
Mailing address:
  • Phone: 508-679-6833
  • Fax: 508-678-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics 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: WAYNE G SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 508-679-6833