Healthcare Provider Details

I. General information

NPI: 1457848293
Provider Name (Legal Business Name): PAUL N. CHERVIN, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 MAIN STREET
WOBURN MA
01801
US

IV. Provider business mailing address

604 MAIN STREET
WOBURN MA
01801
US

V. Phone/Fax

Practice location:
  • Phone: 781-935-3710
  • Fax: 781-935-3410
Mailing address:
  • Phone: 781-935-3710
  • Fax: 781-935-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number30811
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number30811
License Number StateMA

VIII. Authorized Official

Name: PAUL N CHERVIN
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 781-935-3710