Healthcare Provider Details

I. General information

NPI: 1275521197
Provider Name (Legal Business Name): CHILDS R ART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HOSPITAL AVE SUITE 302
NORTH ADAMS MA
01247-2550
US

IV. Provider business mailing address

77 HOSPITAL AVE SUITE 302
NORTH ADAMS MA
01247-2550
US

V. Phone/Fax

Practice location:
  • Phone: 413-663-8365
  • Fax: 413-662-2363
Mailing address:
  • Phone: 413-663-8365
  • Fax: 413-662-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215667
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: