Healthcare Provider Details

I. General information

NPI: 1962708271
Provider Name (Legal Business Name): TLC PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 BEACH ST
REVERE MA
02151-3143
US

IV. Provider business mailing address

280 BEACH ST
REVERE MA
02151-3143
US

V. Phone/Fax

Practice location:
  • Phone: 781-289-5057
  • Fax: 781-289-4485
Mailing address:
  • Phone: 781-289-5057
  • Fax: 781-289-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JANET TIENG CHUA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 781-289-5057