Healthcare Provider Details

I. General information

NPI: 1831131333
Provider Name (Legal Business Name): WEST SUBURBAN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 WASHINGTON ST
WELLESLEY HILLS MA
02481-4964
US

IV. Provider business mailing address

258 WASHINGTON ST
WELLESLEY HILLS MA
02481-4964
US

V. Phone/Fax

Practice location:
  • Phone: 781-431-2360
  • Fax: 781-431-2366
Mailing address:
  • Phone: 781-431-2360
  • Fax: 781-431-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES I GOLDSTON
Title or Position: PRESIDENT
Credential: MD
Phone: 781-431-2360