1780710640 NPI number — PEDIATRICS AT NEWTON WELLESLEY, PC

Table of content: DR. ERIN BEEBE HARDIE O.D. (NPI 1467700898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780710640 NPI number — PEDIATRICS AT NEWTON WELLESLEY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRICS AT NEWTON WELLESLEY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780710640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE #466
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02462-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-969-8989
Provider Business Mailing Address Fax Number:
617-928-0178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE #466
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02462-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-969-8989
Provider Business Practice Location Address Fax Number:
617-928-0178
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIDEOUT
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
617-969-8989

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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