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General NPI Number Information
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NPI Number | 1730544461
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEALTH CARE COOPERATIVE
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 372 CHANDLER ST SUITE 104
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City | WORCESTER
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State | MA
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Zip | 01602-3314
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Country | US
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Telephone | 508-767-3997
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Fax | 508-767-3999
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Provider Business Mailing Address
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Address Line | 372 CHANDLER ST SUITE 104
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City | WORCESTER
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State | MA
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Zip | 01602-3314
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Country | US
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Telephone | 508-767-3997
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Fax | 508-767-3999
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CHRISTINE FREEMER
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Credential | M.D.
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Telephone | 508-767-3997
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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 | 202628
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License Number State | MA
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