Organization
CROWN COLONY PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE RONNIE BLACHMAN M.D. (PRESIDENT)
(617) 471-3411
Entity
Organization
Contact information
Practice address
500 CONGRESS ST, SUITE 1F, QUINCY, MA 02169-0908
(617) 471-3411
Mailing address
500 CONGRESS ST, SUITE 1F, QUINCY, MA 02169-0908
(617) 471-3411
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9782362
—
MA
Enumeration date
06/03/2006
Last updated
08/22/2020
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