=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205903721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROTHFELD CENTER FOR INTEGRATIVE MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 01/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 MASSACHUSETTS AVE SUITE 303
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02474-8448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-641-1901
-----------------------------------------------------
Fax | 781-641-3963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 MASSACHUSETTS AVE SUITE 303
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02474-8448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-641-1901
-----------------------------------------------------
Fax | 781-641-3963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE DIRECTOR
-----------------------------------------------------
Name | MS. LISA B ADDISON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 781-641-1901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------