Healthcare Provider Details

I. General information

NPI: 1992800957
Provider Name (Legal Business Name): TOWN CENTER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 CORDAVILLE RD SUITE 185
SOUTHBOROUGH MA
01772-1838
US

IV. Provider business mailing address

PO BOX 296
SOUTHBOROUGH MA
01772-0296
US

V. Phone/Fax

Practice location:
  • Phone: 508-229-8811
  • Fax: 508-229-0666
Mailing address:
  • Phone: 508-229-8811
  • Fax: 508-229-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUTH SPAULDING
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-229-8811