Healthcare Provider Details

I. General information

NPI: 1932258654
Provider Name (Legal Business Name): PLEASANT HILL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PLEASANT ST
WEST BRIDGEWATER MA
02379-1506
US

IV. Provider business mailing address

22 PLEASANT ST
WEST BRIDGEWATER MA
02379-1506
US

V. Phone/Fax

Practice location:
  • Phone: 508-588-6200
  • Fax: 508-588-6211
Mailing address:
  • Phone: 508-588-6200
  • Fax: 508-588-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDA L MORALES
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-586-4702