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General NPI Number Information
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NPI Number | 1659381192
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Entity Type | Organization
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Legal Business Name | SUBURBAN INTERNAL MEDICINE, INC.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 710 STOCKBRIDGE RD
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City | LEE
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State | MA
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Zip | 01238-9316
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Country | US
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Telephone | 413-243-0122
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Fax | 413-243-2251
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Provider Business Mailing Address
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Address Line | PO BOX 709 710 STOCKBRIDGE RD
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City | LEE
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State | MA
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Zip | 01238-0709
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Country | US
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Telephone | 413-243-0122
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Fax | 413-243-2251
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURIE MITCHELL
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Credential |
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Telephone | 413-243-0122
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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 | 205153
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 160149
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 152983
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 55555
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License Number State | MA
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