Organization
CHILDREN'S UROLOGICAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN M HICKEY (PROVIDER ENROLLMENT MANAGER)
(617) 355-4956
Entity
Organization
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6136
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6136
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
208800000X
Urology Physician
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
07/28/2006
Last updated
12/11/2025
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