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General NPI Number Information
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NPI Number | 1740304666
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Entity Type | Organization
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Legal Business Name | LAURIE B. BOTIE, MD, PC
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 600 CLARK RD
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City | TEWKSBURY
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State | MA
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Zip | 01876-1699
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Country | US
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Telephone | 978-453-9272
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Fax | 978-970-1506
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Provider Business Mailing Address
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Address Line | 600 CLARK RD
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City | TEWKSBURY
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State | MA
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Zip | 01876-1699
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Country | US
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Telephone | 978-453-9272
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Fax | 978-970-1506
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURIE B. BOTIE
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Credential | MD
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Telephone | 978-453-9272
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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 | 46137
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License Number State | MA
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