Provider Demographics
NPI:1053927574
Name:BOSTON COMMUNITY PEDIATRICS INC
Entity type:Organization
Organization Name:BOSTON COMMUNITY PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RISEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-934-6009
Mailing Address - Street 1:527 ALBANY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2511
Mailing Address - Country:US
Mailing Address - Phone:617-934-6009
Mailing Address - Fax:617-934-7102
Practice Address - Street 1:527 ALBANY ST STE 200
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2511
Practice Address - Country:US
Practice Address - Phone:617-934-6009
Practice Address - Fax:617-934-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty