=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861479115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY A. CHABOT MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2005
-----------------------------------------------------
Last Update Date | 04/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 WORCESTER ST HARVARD VANGUARD MEDICAL ASSOC, PEDIATRIC URGENT CARE
-----------------------------------------------------
City | WELLESLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02481-5420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-431-5230
-----------------------------------------------------
Fax | 781-431-5518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 MILK ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02109-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-559-8239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 57371
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------