NPIMap

Individual provider Active NPI

Vikki Louise Noonan, D.M.D., D.M.SC.

  • Oral and Maxillofacial Pathology Dentistry
  • Boston, MA
National Provider Identifier
1619980745
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
19519 Issued in MA
Practice address
133 Brookline Ave
6TH Floor;Harvard Vanguard Medical Assoc.;Dept of Path.
Boston, MA 02215-3904
Phone
(617) 421-2844
Fax
(617) 421-2423
NPI assigned
Aug 13, 2006
Last updated
Mar 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 19519 MA Primary

Addresses

Primary practice location

133 Brookline Ave
6TH Floor;Harvard Vanguard Medical Assoc.;Dept of Path.
Boston, MA 02215-3904

Mailing address

133 Brookline Ave
6TH Floor;Harvard Vanguard Medical Assoc.;Dept of Path.
Boston, MA 02215-3904
Phone (617) 421-2844

Other practice location 1

1 Cranberry Hl
Lexington, MA 02421-7394
Phone (800) 325-7284

Other identifiers 3

IdentifierTypeStateIssuer
0203718MedicaidMA
AA27554OtherHARVARD PILGRIM
X09107OtherBLUE CROSS

Other names 1

  • Vikki Louise Vaughn Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041210000493 MA Practitioner - DentistPractitioner - Pathology 2466419536 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
DentistAlso: Pathology
Education
Tufts University School of Dental Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Strata Pathology Services, IncGroup PAC ID 3779503560, 14 clinicians
Trustees of Boston UniversityGroup PAC ID 8921070822, 43 clinicians

Practice addresses (Care Compare)

1 Cranberry HL
Suite 105
Lexington, MA 02421-7397
Phone (800) 325-7284

100 E Newton St
G407
Boston, MA 02118-3552
Phone (617) 638-4350

725 Albany St
Boston, MA 02118-2526
Phone (617) 638-1058

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19519MAMDOral and Maxillofacial Pathology Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Strata Pathology Services, Inc. CurrentSince Sep 1, 2010 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients
Strata Pathology Services Inc CurrentSince Sep 1, 2010 Accepting new patients
Trustees of Boston University Past Accepting new patients

Locations

1 Cranberry Hl
Lexington, MA 02421
Phone (617) 401-4757

1 Cranberry Hl
Ste 105
Lexington, MA 02421
Phone (800) 325-7284

1 Cranberry Hl
Ste 303
Lexington, MA 02421
Phone (678) 679-9059

Interoperability endpoints

  • Direct secure messaging: vnoonan86216@direct.bmc.masshiway.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1619980745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 BROOKLINE AVE",
            "address_2": "6TH FLOOR;HARVARD VANGUARD MEDICAL ASSOC.;DEPT OF PATH.",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022153904",
            "telephone_number": "617-421-2844",
            "fax_number": "617-421-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 BROOKLINE AVE",
            "address_2": "6TH FLOOR;HARVARD VANGUARD MEDICAL ASSOC.;DEPT OF PATH.",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022153904",
            "telephone_number": "617-421-2844",
            "fax_number": "617-421-2423"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Cranberry Hl",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "MA",
            "postal_code": "024217394",
            "country_code": "US",
            "telephone_number": "800-325-7284",
            "fax_number": "205-579-9387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOONAN",
        "first_name": "VIKKI",
        "middle_name": "LOUISE",
        "credential": "D.M.D., D.M.SC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-13",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "MA",
            "license": "19519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0203718",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA27554",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "X09107",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIKKI",
            "last_name": "VAUGHN",
            "middle_name": "LOUISE",
            "credential": "D.M.D., D.M.SC.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.