Healthcare Provider Details

I. General information

NPI: 1659381192
Provider Name (Legal Business Name): SUBURBAN INTERNAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 STOCKBRIDGE RD
LEE MA
01238-9316
US

IV. Provider business mailing address

PO BOX 709 710 STOCKBRIDGE RD
LEE MA
01238-0709
US

V. Phone/Fax

Practice location:
  • Phone: 413-243-0122
  • Fax: 413-243-2251
Mailing address:
  • Phone: 413-243-0122
  • Fax: 413-243-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number205153
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number160149
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number152983
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55555
License Number StateMA

VIII. Authorized Official

Name: LAURIE MITCHELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 413-243-0122