Healthcare Provider Details

I. General information

NPI: 1366903551
Provider Name (Legal Business Name): VANTAGE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DAN RD
CANTON MA
02021
US

IV. Provider business mailing address

PO BOX 411488
BOSTON MA
02241-1488
US

V. Phone/Fax

Practice location:
  • Phone: 781-867-2050
  • Fax:
Mailing address:
  • Phone: 781-867-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JAMIE L ELLIOTT
Title or Position: COO
Credential:
Phone: 781-867-2050