1023060035 NPI number — ANAESTHESIA ASSOCIATES OF MASSACHUSETTS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023060035 NPI number — ANAESTHESIA ASSOCIATES OF MASSACHUSETTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANAESTHESIA ASSOCIATES OF MASSACHUSETTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW ENGLAND PAIN MANAGEMENT CONSULTANTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023060035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 414422
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-4422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-407-7713
Provider Business Mailing Address Fax Number:
781-407-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 MOUNT AUBURN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-499-5075
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCIVOR
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
781-407-7713

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9761674 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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