Provider Demographics
NPI:1285700831
Name:LEAHY, NOREEN MARIE (NP)
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:MARIE
Last Name:LEAHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT STREET MASSACHUSETT GENERAL HOSPITAL
Mailing Address - Street 2:YAWKEY 9E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-8770
Mailing Address - Fax:617-724-8769
Practice Address - Street 1:55 FRUIT STREET MGH
Practice Address - Street 2:YAWKEY 9E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0398161Medicaid
MANP4406Medicare ID - Type Unspecified