Organization
HOLLISTONPEDIATRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA L VAILLETTE (PRACTICE MANAGER)
(508) 478-5996
Entity
Organization
Contact information
Practice address
100 JEFFREY AVE, HOLLISTON, MA 01746-2028
(508) 478-5996
(508) 482-9147
Mailing address
100 JEFFREY AVE, HOLLISTON, MA 01746
(508) 478-5996
(508) 482-9147
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
52479
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
701376
TUFTS HEALTH PLAN
MA
05
—
9749403
—
MA
01
—
M10882
BLUE CROSS BLUE SHIELD
MA
Enumeration date
07/12/2006
Last updated
08/22/2020
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