MEDICARE: BOSTON CHILDREN'S HOSPITAL

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	282NC2000X	Children's Hospital		MA

General Provider Information

NPI Number	:	1366782518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON CHILDREN'S HOSPITAL

Provider Business Mailing Address
First Line	:	11 HEREFORD ST
Second Line	:	APT 4R
City	:	BOSTON
State	:	MA
Zip	:	02115-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 HEREFORD ST
Second Line	:	APT 4R
City	:	BOSTON
State	:	MA
Zip	:	02115-1602
Country	:	US
Telephone Number	:	617-602-9730
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT
Name	:	DR. COLLEEN HEFFERNAN
Credential	:	MD
Telephone Number	:	617-602-9730

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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Directions to “BOSTON CHILDREN'S HOSPITAL ” Practice Location

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