Healthcare Provider Details

I. General information

NPI: 1861479115
Provider Name (Legal Business Name): WENDY A. CHABOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WORCESTER ST HARVARD VANGUARD MEDICAL ASSOC, PEDIATRIC URGENT CARE
WELLESLEY MA
02481-5420
US

IV. Provider business mailing address

147 MILK ST
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 781-431-5230
  • Fax: 781-431-5518
Mailing address:
  • Phone: 617-559-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57371
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: