Healthcare Provider Details

I. General information

NPI: 1861505000
Provider Name (Legal Business Name): NICHOLAS H MAYPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

269 UNION ST NORTH SHORE HEALTH SYSTEMS
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-3900
  • Fax: 781-598-1050
Mailing address:
  • Phone: 978-354-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number212845
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: