Basic Information
| Provider Information | |||||||||
| NPI: | 1467487421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIES | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MAIN STREET PEDIATRICS | ||||||||
| Address2: | 77 WEST MAIN STREET | ||||||||
| City: | HOPKINTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084355506 | ||||||||
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| Practice Location | |||||||||
| Address1: | MAIN STREET PEDIATRICS | ||||||||
| Address2: | 77 WEST MAIN STREET | ||||||||
| City: | HOPKINTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084355506 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 208000000X | 156562 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 156562 | 01 | MA | TUFTS | OTHER | 202206 | 01 | MA | HARVARD PILGRIM | OTHER | 0103870 | 05 | MA | MEDICAID | 2121339 | 01 | MA | AETNA US HEALTHCARE | OTHER | 12-01600 | 01 | MA | UNITED HEALTHCARE | OTHER | J22134 | 01 | MA | BLUE CROSS/BLUE SHIELD | OTHER | 5842725 | 01 | MA | AETNA | OTHER | B10363601 | 01 | MA | CIGNA | OTHER |