Healthcare Provider Details

I. General information

NPI: 1285096719
Provider Name (Legal Business Name): KIDSWELL PEDIATRICS & URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 WASHINGTON ST
NEWTON MA
02458-1612
US

IV. Provider business mailing address

299 WASHINGTON ST
NEWTON MA
02458-1612
US

V. Phone/Fax

Practice location:
  • Phone: 617-340-8899
  • Fax: 617-916-0893
Mailing address:
  • Phone: 617-340-8899
  • Fax: 617-916-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number222689
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number222689
License Number StateMA

VIII. Authorized Official

Name: JANET HSU-LIN
Title or Position: CHIEF PHYSICIAN
Credential: M.D.
Phone: 617-340-8899