NPI 1235180100 · live from the CMS NPI Registry
Beaver Brook Pediatric & Adolescent Medicine, P.C.
Pediatrics, Adolescent Medicine in Waltham, MA. National Provider Identifier 1235180100, active.
NPI record
| NPI | 1235180100 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pediatrics, Adolescent Medicine 2080A0000X |
| Practice location | 465 Waverley Oaks Rd, Suite 100, Waltham, MA 02452 |
| Practice phone | 781-891-3706 |
| Enumerated | May 15, 2006 |
| Last updated | January 21, 2020 |
| Authorized official | Janet Antonioni, Owner/Provider |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics, Adolescent Medicine primary | 2080A0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.