Healthcare Provider Details

I. General information

NPI: 1982949467
Provider Name (Legal Business Name): JENNIFER L BARKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L BALENTINE PA

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8100
  • Fax: 781-744-5213
Mailing address:
  • Phone: 781-744-8100
  • Fax: 781-744-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4918
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00694
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: