Healthcare Provider Details

I. General information

NPI: 1730544461
Provider Name (Legal Business Name): CHILDREN'S HEALTH CARE COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 CHANDLER ST SUITE 104
WORCESTER MA
01602-3314
US

IV. Provider business mailing address

372 CHANDLER ST SUITE 104
WORCESTER MA
01602-3314
US

V. Phone/Fax

Practice location:
  • Phone: 508-767-3997
  • Fax: 508-767-3999
Mailing address:
  • Phone: 508-767-3997
  • Fax: 508-767-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202628
License Number StateMA

VIII. Authorized Official

Name: DR. CHRISTINE FREEMER
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 508-767-3997