Healthcare Provider Details

I. General information

NPI: 1649281973
Provider Name (Legal Business Name): MIRNA AESCHLIMANN MD FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 MAIN STREET
STONEHAM MA
02180
US

IV. Provider business mailing address

577 MAIN STREET
STONEHAM MA
02180
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-7330
  • Fax: 781-279-4046
Mailing address:
  • Phone: 781-438-7330
  • Fax: 781-279-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32593
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9768904
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: