Healthcare Provider Details

I. General information

NPI: 1053940031
Provider Name (Legal Business Name): SARAH ANN BOTTIGLIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 11/07/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WHIDDEN HOSPITAL, 103 GARLAND STREET
EVERETT MA
02149
US

IV. Provider business mailing address

103 GARLAND ST
EVERETT MA
02149-5066
US

V. Phone/Fax

Practice location:
  • Phone: 617-394-7731
  • Fax:
Mailing address:
  • Phone: 617-389-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH238984
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: