Provider Demographics
NPI:1528556529
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:781-744-8330
Mailing Address - Fax:
Practice Address - Street 1:LAHEY HEALTH PRIMARY CARE, LYNNFIELD
Practice Address - Street 2:1350 MARKET STREET, 2ND FLOOR
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940
Practice Address - Country:US
Practice Address - Phone:781-213-4040
Practice Address - Fax:781-213-5064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL LAHEY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-25
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty