MEDICARE: WESTON PEDIATRIC PHYSICIANS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		MA

General Provider Information

NPI Number	:	1134284417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTON PEDIATRIC PHYSICIANS, P.C.

Provider Business Mailing Address
First Line	:	486 BOSTON POST RD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-1529
Country	:	US
Telephone Number	:	781-899-5636
Fax Number	:	781-647-9578

Provider Business Practice Location Address
First Line	:	486 BOSTON POST RD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-1529
Country	:	US
Telephone Number	:	781-899-5636
Fax Number	:	781-647-9578

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	THORN RENEE
Credential	:
Telephone Number	:	781-899-5636

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/21/2022

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