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General NPI Number Information
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NPI Number | 1629185202
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Entity Type | Individual
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Provider Name | AMANDA S GROWDON M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 300 LONGWOOD AVE, MAIN S 9156 CHILDREN'S HOSPITAL BOSTON
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City | BOSTON
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State | MA
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Zip | 02115
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Country | US
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Telephone | 617-355-4993
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Fax | 617-730-0884
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Provider Business Mailing Address
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Address Line | 1 CHARLES ST S UNIT 2D
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City | BOSTON
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State | MA
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Zip | 02116-5447
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Country | US
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Telephone | 617-355-4993
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Fax | 617-730-0884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 227056
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License Number State | MA
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