Provider Demographics
NPI:1992800957
Name:TOWN CENTER PEDIATRICS
Entity type:Organization
Organization Name:TOWN CENTER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-229-8811
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-0296
Mailing Address - Country:US
Mailing Address - Phone:508-229-8811
Mailing Address - Fax:508-229-0666
Practice Address - Street 1:162 CORDAVILLE RD
Practice Address - Street 2:SUITE 185
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1838
Practice Address - Country:US
Practice Address - Phone:508-229-8811
Practice Address - Fax:508-229-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
44778OtherFALLON COMMUNITY HEALTH P
615411OtherTUFTS HEALTH PLAN
MAM16823OtherBLUECROSS BLUE SHIELD
MA9783164Medicaid