Healthcare Provider Details

I. General information

NPI: 1831819226
Provider Name (Legal Business Name): LAUREN KIERIAN ROSLYN HILDRETH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN KIERIAN ROSLYN BIRCH PA-C

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DAVIS STRAITS
FALMOUTH MA
02540-3906
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 774-244-3227
  • Fax:
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: