Basic Information
| Provider Information | |||||||||
| NPI: | 1164849089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTES | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | GOODLOE | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GOODLOE | ||||||||
| OtherFirstName: | MEREDITH | ||||||||
| OtherMiddleName: | MAXWELL | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 103 FOX RD UNIT 622 | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024510206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349964843 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 41 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817299000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2014 | ||||||||
| LastUpdateDate: | 05/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 270070 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.