Basic Information
Provider Information
NPI: 1760641922
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SODERLAND
FirstName: PETER
MiddleName: ALBERT
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 41 MALL RD.
Address2: LAHEY CLINIC
City: BURLINGTON
State: MA
PostalCode: 018050001
CountryCode: US
TelephoneNumber: 7817447000
FaxNumber: 7817445378
Practice Location
Address1: 41 MALL RD.
Address2: LAHEY CLINIC
City: BURLINGTON
State: MA
PostalCode: 018050001
CountryCode: US
TelephoneNumber: 7817447000
FaxNumber: 7817445378
Other Information
ProviderEnumerationDate: 06/03/2008
LastUpdateDate: 07/27/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X248310MAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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