Provider Demographics
NPI:1053423087
Name:CAPE COD PEDIATRICS LLP
Entity type:Organization
Organization Name:CAPE COD PEDIATRICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-477-5306
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0549
Mailing Address - Country:US
Mailing Address - Phone:508-477-5306
Mailing Address - Fax:508-447-0297
Practice Address - Street 1:53 ROUTE 130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1402
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:508-477-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781854Medicaid
MAM17770OtherBLUE CROSS BLUE SHIELD OF