Provider Demographics
NPI:1174042337
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-744-8097
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 HEALTH PRIMARY CARE, NORTH ANDOVER
Practice Address - Street 2:170 PLEASANT ST.
Practice Address - City:N. ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-685-4925
Practice Address - Fax:978-682-3637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL LAHEY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-19
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty