Healthcare Provider Details

I. General information

NPI: 1982900536
Provider Name (Legal Business Name): GAIL ELAINE HURLEY-GOODSON PA-C, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL ELAINE HURLEY PA-C, MHS

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/17/2014
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: 781-744-7000
  • Fax: 781-744-7516
Mailing address:
  • Phone: 781-744-7000
  • Fax: 781-744-7516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0887
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA4068
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: