Provider Demographics
NPI:1588290324
Name:LIGHTHOUSE PRIMARY CARE PC
Entity type:Organization
Organization Name:LIGHTHOUSE PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCWHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-276-0100
Mailing Address - Street 1:315 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-1326
Mailing Address - Country:US
Mailing Address - Phone:978-276-0100
Mailing Address - Fax:978-276-0041
Practice Address - Street 1:315 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-1326
Practice Address - Country:US
Practice Address - Phone:978-276-0100
Practice Address - Fax:978-276-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty