Healthcare Provider Details

I. General information

NPI: 1104237197
Provider Name (Legal Business Name): STEPHANIE FRITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date: 08/25/2020
Reactivation Date: 05/22/2024

III. Provider practice location address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

IV. Provider business mailing address

1 MAGUIRE RD
LEXINGTON MA
02421-3114
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: