=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720496193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH A PESCATORE N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 07/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | LAHEY CLINIC INC 41 MALL ROAD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01805-1598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-744-8085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 480 MAPLE ST
-----------------------------------------------------
City | DANVERS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01923-4065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-304-8020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2270708
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------