Basic Information
| Provider Information | |||||||||
| NPI: | 1366010571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEAVEY | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225B FALLON RD APT 441 | ||||||||
| Address2: | |||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021802938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044411678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41 BURLINGTON MALL ROAD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817445100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2021 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 288810 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 268810 | MA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.