Organization
BEAVER BROOK PEDIATRIC & ADOLESCENT MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET L ANTONIONI (OWNER/PROVIDER)
(781) 891-3706
Entity
Organization
Contact information
Practice address
465 WAVERLEY OAKS RD, SUITE 100, WALTHAM, MA 02452-8438
(781) 891-3706
(781) 891-3564
Mailing address
465 WAVERLEY OAKS RD, SUITE 100, WALTHAM, MA 02452-8438
(781) 891-3706
(781) 891-3564
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110074250A
—
MA
Enumeration date
05/15/2006
Last updated
01/21/2020
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