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NPI Code Detail

MEDICARE: CHILDREN'S HOSPITAL RADIOLOGY FOUNDATION, INC.

MEDICARE: CHILDREN'S HOSPITAL RADIOLOGY FOUNDATION, INC.
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
1363LP0200XPediatric Nurse Practitioner
2363LF0000XFamily Nurse Practitioner
32085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487681912
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S HOSPITAL RADIOLOGY FOUNDATION, INC.
Provider Business Mailing Address
First Line : 300 LONGWOOD AVE
Second Line : DEPARTMENT OF RADIOLOGY
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 LONGWOOD AVE
Second Line : DEPARTMENT OF RADIOLOGY
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number : 617-355-8382
Fax Number :
Authorized Official
Title or Position : RADIOLOGIST IN CHIEF
Name : DR. TINA POUSSAINT
Credential :
Telephone Number : 617-355-6450
Provider Enumeration Date : 06/28/2006
Last Update Date : 06/15/2026

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