Active NPI
Lynda Marie Bannon, L ATC
- Athletic Trainer
- Burlington, MA
National Provider Identifier
1063000214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 418
- Practice address
- 123 Cambridge St
Burlington, MA 01803-3711 - Phone
- (781) 270-1883
- NPI assigned
- Jan 4, 2021
- Last updated
- Jan 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 418 | MA | Primary |
Addresses
Primary practice location
123 Cambridge St
Burlington, MA 01803-3711
Mailing address
38 Highland St
Medway, MA 02053-2105
Phone (508) 533-9002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 418 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1063000214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 HIGHLAND ST",
"city": "MEDWAY",
"state": "MA",
"postal_code": "020532105",
"telephone_number": "508-533-9002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 CAMBRIDGE ST",
"city": "BURLINGTON",
"state": "MA",
"postal_code": "018033711",
"telephone_number": "781-270-1883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNON",
"first_name": "LYNDA",
"middle_name": "MARIE",
"credential": "L ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-04",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.