Active NPI
Matthew Boaz Lake, MD
- Anesthesiology Physician
- Lebanon, NH
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 0101269652
- Practice address
- 1 Medical Center Dr
DHMC Dept. of Anesthesiology
Lebanon, NH 03756-1000 - Phone
- (603) 650-6177
- NPI assigned
- Apr 21, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 18330 | NH | |
| Anesthesiology Physician | 207L00000X | 0101269652 | VA | Primary |
Addresses
Primary practice location
1 Medical Center Dr
DHMC Dept. of Anesthesiology
Lebanon, NH 03756-1000
Mailing address
1 Medical Center Dr
DHMC Dept. of Anesthesiology
Lebanon, NH 03756-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Anesthesiology
- Education
- West Virginia University School of Medicine, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1305 Walt Whitman Rd
Suite 300
Melville, NY 11747-4300
1500 Commonwealth Ave
Williamsburg, VA 23185-5229
Phone (757) 585-2200
19455 Deerfield Ave
Suite 204
Leesburg, VA 20176-8102
Phone (703) 724-9950
500 J Clyde Morris Blvd
Newport News, VA 23601-1929
Phone (757) 594-2000
Hospital & facility affiliations
- Riverside Regional Medical Center
- Riverside Doctors' Hospital of Williamsburg
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18330 | NH | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Anesthesiology of Virginia PC | Anesthesiology | Current | Accepting new patients |
| Northstar Anesthesia of Virginia, LLC | Anesthesiology | Current | Accepting new patients |
| American Anesthesiology of Virginia, PC | Anesthesiology | Current | Accepting new patients |
Locations
1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796
736 Battlefield Blvd N
Chesapeake, VA 23320
Phone (757) 312-6124
541 Sunset Ln
Ste 201
Culpeper, VA 22701
Phone (540) 829-0700
19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anesthesiology Physician
- Falls Church, VA
- NPI 1417994872
-
- Anesthesiology Physician
- Alexandria, VA
- NPI 1194488791
-
- Anesthesiology Physician
- Leesburg, VA
- NPI 1053675199
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Williamsburg, VA
- NPI 1275893307
-
- General Acute Care Hospital
- Newport News, VA
- NPI 1366547747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735516800000",
"number": "1992192520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER DR",
"address_2": "DHMC DEPT. OF ANESTHESIOLOGY",
"city": "LEBANON",
"state": "NH",
"postal_code": "037561000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER DR",
"address_2": "DHMC DEPT. OF ANESTHESIOLOGY",
"city": "LEBANON",
"state": "NH",
"postal_code": "037561000",
"telephone_number": "603-650-6177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "MATTHEW",
"middle_name": "BOAZ",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-21",
"last_updated": "2024-12-30",
"certification_date": "2024-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NH",
"license": "18330",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "VA",
"license": "0101269652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.