Provider Demographics
NPI:1790961043
Name:LAHEY CLINIC HOSPITAL INC
Entity Type:Organization
Organization Name:LAHEY CLINIC HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
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:LAHEY CLINIC OPTICAL SHOP
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-5703
Mailing Address - Fax:
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY CLINIC OPTICAL SHOP
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0002
Practice Address - Country:US
Practice Address - Phone:781-744-8830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0992350001Medicare NSC
MA0992350002Medicare NSC
MA0992350003Medicare NSC