Healthcare Provider Details

I. General information

NPI: 1245253715
Provider Name (Legal Business Name): BARRY ZITIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY CLINIC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

LAHEY CLINIC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8963
  • Fax: 781-744-5235
Mailing address:
  • Phone: 781-744-8963
  • Fax: 781-744-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36794
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: