Healthcare Provider Details

I. General information

NPI: 1003403346
Provider Name (Legal Business Name): DEB RIGGOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 LINCOLN RD
SUDBURY MA
01776-1409
US

IV. Provider business mailing address

1 STONE HILL TER
WALPOLE MA
02081-2612
US

V. Phone/Fax

Practice location:
  • Phone: 508-451-2730
  • Fax:
Mailing address:
  • Phone: 508-451-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberAT-306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: