Basic Information
| Provider Information | |||||||||
| NPI: | 1861479115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHABOT | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598239 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 WORCESTER ST | ||||||||
| Address2: | HARVARD VANGUARD MEDICAL ASSOC, PEDIATRIC URGENT CARE | ||||||||
| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024815420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814315230 | ||||||||
| FaxNumber: | 7814315518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 57371 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 04-2817581 | 01 | MA | CONSOLIDATED | OTHER | 04-2817851 | 01 | MA | NORTHEAST HEALTH DIRECT | OTHER | 04-2817581 | 01 | MA | UNICARE/GIC | OTHER | 057371 | 01 | MA | CONNECTICARE | OTHER | 765496 | 01 | MA | TUFTS | OTHER | 04-2817581 | 01 | MA | NORTH AMERICAN PREFERRED | OTHER | 3399802 | 01 | MA | AETNA | OTHER | J06605 | 01 | MA | BCBSMA | OTHER | 3020720 | 05 | MA | MEDICAID | 04-2817581 | 01 | MD | PIONEER PPO | OTHER | 04-2817581 | 01 | MA | PLAN VISTA | OTHER | 24863 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 782963010 | 01 | MA | CIGNA | OTHER | 000000008062 | 01 | MA | BMC | OTHER | 04-2817581 | 01 | MA | GREAT-WEST | OTHER | 04-2817581 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | 202153 | 01 | MA | HARVARD PILGRIM | OTHER |