Healthcare Provider Details

I. General information

NPI: 1265411433
Provider Name (Legal Business Name): CAROL HARTIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
ROXBURY CROSSING MA
02120-2847
US

IV. Provider business mailing address

91 STILES RD ATTN SHARON SILVA
SALEM NH
03079-2846
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5800
  • Fax:
Mailing address:
  • Phone: 800-927-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number73726
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: