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General NPI Number Information
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NPI Number | 1174436430
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Entity Type | Organization
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Legal Business Name | LOTUS PRIMARY CARE PLLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 125 UNDERPASS RD
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City | BREWSTER
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State | MA
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Zip | 02631-1810
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Country | US
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Telephone | 508-625-6963
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Fax |
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Provider Business Mailing Address
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Address Line | 125 UNDERPASS RD
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City | BREWSTER
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State | MA
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Zip | 02631-1810
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Country | US
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Telephone | 508-625-6963
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW LIBBY
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Credential | DO
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Telephone | 508-625-6963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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