Provider Demographics
NPI:1801982541
Name:GANTZ, VICTORIA H (NP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:H
Last Name:GANTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:LAHEY CLINIC
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-5100
Mailing Address - Fax:781-744-5215
Practice Address - Street 1:550 CABOT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2511
Practice Address - Country:US
Practice Address - Phone:978-927-1919
Practice Address - Fax:978-927-6102
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA161983363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0383520Medicaid
MANP115002Medicare PIN
MAA58418Medicare UPIN