Healthcare Provider Details

I. General information

NPI: 1053584037
Provider Name (Legal Business Name): CARMI SANTOS PUNZALAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. CARMI MARTHA SANTOS

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL ROAD LAHEY HOSPITAL & MEDICAL CENTER
BURLINGTON MA
01805
US

IV. Provider business mailing address

41 MALL ROAD LAHEY HOSPITAL & MEDICAL CENTER
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax: 781-744-5743
Mailing address:
  • Phone: 781-744-8000
  • Fax: 781-744-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number262302
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number262302
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA140736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: