Beaver Brook Pediatric & Adolescent Medicine, P.C.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

BEAVER BROOK PEDIATRIC & ADOLESCENT MEDICINE, P.C.

Practice address

465 Waverley Oaks Rd
Suite 100
Waltham, MA 02452-8438

Phone

(781) 891-3706

Fax

(781) 891-3564

NPI assigned

May 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janet L Antonioni

Title

Owner/Provider

Phone

(781) 891-3706

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2098/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1235180100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 WAVERLEY OAKS RD",
            "address_2": "SUITE 100",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024528438",
            "telephone_number": "781-891-3706",
            "fax_number": "781-891-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 WAVERLEY OAKS RD",
            "address_2": "SUITE 100",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024528438",
            "telephone_number": "781-891-3706",
            "fax_number": "781-891-3564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER BROOK PEDIATRIC & ADOLESCENT MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "ANTONIONI",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "781-891-3706"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110074250A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlos F Bazoberry, M.D.
• Be Physical Therapy, LLC
• Beacon Dental Partners LLC
• Ashley Maryann Beato, PT, DPT
• Pedro L Beato
• Bruce Becker, MD
• Richard L Beckman, M.D.
• Ashley Bedard
• Brittany Bedard
• Joshua Beebe, LICSW

• Pediatric Adolescent Medicine Physician in Waltham, MA
• Providers in Waltham, MA by specialty
• Pediatric Adolescent Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.