Healthcare Provider Details

I. General information

NPI: 1487865978
Provider Name (Legal Business Name): JANICE PRIDE-BOONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE PRIDE

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NORTH STREET SUITE 305
PITTSFIELD MA
01201
US

IV. Provider business mailing address

P.O. BOX 30
GREAT BARRINGTON MA
01230
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-8531
  • Fax: 413-499-8560
Mailing address:
  • Phone: 413-528-9311
  • Fax: 413-644-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 40684
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 62966
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 1582941
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLA MD 13859R
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 11342
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG151811
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number281853
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: