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General NPI Number Information
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NPI Number | 1710461884
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Entity Type | Individual
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Provider Name | MARINA CECILIA ANASTOPOULOS MS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | LAHEY HOSPITAL AND MEDICAL CENTER 41 MALL ROAD
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City | BURLINGTON
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State | MA
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Zip | 01805-0001
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Country | US
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Telephone | 781-744-8085
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Fax | 781-744-5433
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Provider Business Mailing Address
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Address Line | 213 HANOVER ST APT 3
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City | BOSTON
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State | MA
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Zip | 02113-2313
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Country | US
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Telephone | 781-686-4088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA6759
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License Number State | MA
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