Healthcare Provider Details

I. General information

NPI: 1912612029
Provider Name (Legal Business Name): BURLINGTON OBGYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CAMBRIDGE ST STE 160
BURLINGTON MA
01803-3767
US

IV. Provider business mailing address

101 CAMBRIDGE ST STE 160
BURLINGTON MA
01803-3767
US

V. Phone/Fax

Practice location:
  • Phone: 781-272-4667
  • Fax: 781-270-4196
Mailing address:
  • Phone: 781-272-4667
  • Fax: 781-270-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE LANE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 781-272-4667