Provider Demographics
NPI:1043710791
Name:BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:BETH ISRAEL LAHEY HEALTH PRIMARY CARE, INC.
Other - Org Name:LAHEY PHYSICIAN COMMUNITY ORGANIZATION I INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-744-1947
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8085
Mailing Address - Fax:
Practice Address - Street 1:LAHEY INSTITUTE OF UROLOGY, BEVERLY
Practice Address - Street 2:41 MALL RD.
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805
Practice Address - Country:US
Practice Address - Phone:978-927-0714
Practice Address - Fax:978-927-9135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL LAHEY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110115155AMedicaid