=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700074788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABINGTON PEDIATRICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2007
-----------------------------------------------------
Last Update Date | 10/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 BROCKTON AVE STE102
-----------------------------------------------------
City | ABINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02351-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-792-1999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 BROCKTON AVE STE102
-----------------------------------------------------
City | ABINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02351-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-792-1999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YARA FERNANDEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 781-792-1999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------