Healthcare Provider Details

I. General information

NPI: 1073418240
Provider Name (Legal Business Name): WALPOLE PEDIATRIC ASSOC., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 PINE ST STE 103
NORFOLK MA
02056-1680
US

IV. Provider business mailing address

31 PINE ST STE 103
NORFOLK MA
02056-1680
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-2200
  • Fax: 508-850-9727
Mailing address:
  • Phone: 508-668-2200
  • Fax: 508-850-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOANNE LEVYA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 508-668-2223