Healthcare Provider Details

I. General information

NPI: 1235201435
Provider Name (Legal Business Name): JESSICA FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY CLINIC 41 MALL RD.
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

PO BOX 3694
BOSTON MA
02241-3694
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8652
  • Fax: 781-744-5848
Mailing address:
  • Phone: 617-355-6028
  • Fax: 617-731-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224336
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number224336
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: