=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740238096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNETTE M KNIGHT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 05/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 881 SOUTH ST
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01420-6252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-342-4437
-----------------------------------------------------
Fax | 978-343-6572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 848647
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02284-8647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-342-4437
-----------------------------------------------------
Fax | 978-343-6572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 59972
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------