Provider Demographics
NPI:1861556961
Name:MIDDLEBORO PEDIATRICS, PC
Entity type:Organization
Organization Name:MIDDLEBORO PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:BORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-947-0630
Mailing Address - Street 1:2 LAKEVILLE BUSINESS PARK
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1236
Mailing Address - Country:US
Mailing Address - Phone:508-947-0630
Mailing Address - Fax:508-947-0639
Practice Address - Street 1:2 LAKEVILLE BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1236
Practice Address - Country:US
Practice Address - Phone:508-947-0630
Practice Address - Fax:508-947-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA713191OtherTUFTS HEALTH CARE GROUP #
MA9718605Medicaid
MA9718605Medicaid