Healthcare Provider Details

I. General information

NPI: 1265587943
Provider Name (Legal Business Name): CHILD HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 LAWRENCE ST
METHUEN MA
01844-4447
US

IV. Provider business mailing address

59 LAWRENCE ST
METHUEN MA
01844-4447
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-0977
  • Fax: 978-685-4394
Mailing address:
  • Phone: 978-685-0977
  • Fax: 978-685-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35420
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: EVAN BRODIE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-685-0977