Provider Demographics
NPI:1669634804
Name:RATHBONE, ANSON CRAWFORD (LIC AC)
Entity type:Individual
Prefix:MR
First Name:ANSON
Middle Name:CRAWFORD
Last Name:RATHBONE
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
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Mailing Address - Street 1:77 BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4737
Mailing Address - Country:US
Mailing Address - Phone:617-697-5723
Mailing Address - Fax:781-324-2640
Practice Address - Street 1:661 SALEM ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4301
Practice Address - Country:US
Practice Address - Phone:617-924-3945
Practice Address - Fax:781-324-2640
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist