Healthcare Provider Details

I. General information

NPI: 1780627505
Provider Name (Legal Business Name): MEREDITH MATTISON PACE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH EDWARDS MATTISON M.D.

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY HOSPITAL & MEDICAL CTR 41 MALL RD.
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

80 DAVISON DR
LINCOLN MA
01773-2216
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8132
  • Fax: 781-744-2273
Mailing address:
  • Phone: 802-299-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number253937
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: