Provider Demographics
NPI:1881081719
Name:SPIEGEL, KAITLIN (PA-C, RD, LDN)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:PA-C, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:925-487-3613
Mailing Address - Fax:
Practice Address - Street 1:41 MALL ROAD LAHEY HOSPITAL AND MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-6110
Practice Address - Country:US
Practice Address - Phone:781-744-3839
Practice Address - Fax:781-744-1597
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5350363AM0700X, 363A00000X
MA3020133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered