Provider Demographics
NPI:1598718645
Name:LALIBERTE, AMY BENEDICT (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BENEDICT
Last Name:LALIBERTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KRISTIN
Other - Last Name:BENEDICT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL RD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8340
Mailing Address - Fax:781-744-5641
Practice Address - Street 1:LAHEY CLINIC
Practice Address - Street 2:41 MALL RD
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8340
Practice Address - Fax:781-744-5641
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3980363A00000X, 363A00000X
NY010896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015776Medicare PIN
MA0015776Medicare PIN
NYQ60540Medicare UPIN
NY02720689Medicaid
SCAA45351680Medicare PIN