Healthcare Provider Details

I. General information

NPI: 1073543260
Provider Name (Legal Business Name): DONALD BARTLETT II P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 GROVELAND ST
HAVERHILL MA
01830-6674
US

IV. Provider business mailing address

288 GROVELAND ST
HAVERHILL MA
01830-6674
US

V. Phone/Fax

Practice location:
  • Phone: 978-373-3851
  • Fax: 978-521-6542
Mailing address:
  • Phone: 978-373-3851
  • Fax: 978-521-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number187342
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: