1114209160 NPI number — MS. STEPHANIE NICHOLE BURNS DPT

Table of content: MS. STEPHANIE NICHOLE BURNS DPT (NPI 1114209160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114209160 NPI number — MS. STEPHANIE NICHOLE BURNS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
STEPHANIE
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114209160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 MALL RD.
Provider Second Line Business Mailing Address:
LAHEY CLINIC
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01805-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-372-7060
Provider Business Mailing Address Fax Number:
781-372-7069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 HAYDEN AVE
Provider Second Line Business Practice Location Address:
LAHEY LEXINGTON
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02421-7929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-372-7060
Provider Business Practice Location Address Fax Number:
781-372-7069
Provider Enumeration Date:
09/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  38111 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 20036 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110093924A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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