Healthcare Provider Details

I. General information

NPI: 1245264456
Provider Name (Legal Business Name): METROWEST PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 EDGELL RD
FRAMINGHAM MA
01701
US

IV. Provider business mailing address

33 EDGELL RD
FRAMINGHAM MA
01701-4833
US

V. Phone/Fax

Practice location:
  • Phone: 508-620-6615
  • Fax: 508-879-1597
Mailing address:
  • Phone: 508-620-6615
  • Fax: 508-879-1597

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:

# 1
IdentifierM17360
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBS
# 2
Identifier688580
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 3
Identifier9786864
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: RAISA W GAINES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 508-620-6615