Provider Demographics
NPI:1215223185
Name:KIDS ON THE COMMON PEDIATRICS
Entity type:Organization
Organization Name:KIDS ON THE COMMON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUGO-FOCHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-839-4440
Mailing Address - Street 1:31 SIBLEY ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1304
Mailing Address - Country:US
Mailing Address - Phone:508-839-4440
Mailing Address - Fax:
Practice Address - Street 1:28 GRAFTON CMN
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1534
Practice Address - Country:US
Practice Address - Phone:508-839-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79059261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care