Healthcare Provider Details

I. General information

NPI: 1679325310
Provider Name (Legal Business Name): SIOBHAN BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH ST FL 5
BOSTON MA
02110-3036
US

IV. Provider business mailing address

2 MALLARD LN
NORTH READING MA
01864-2169
US

V. Phone/Fax

Practice location:
  • Phone: 617-221-6909
  • Fax:
Mailing address:
  • Phone: 781-315-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA100782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: