1023209186 NPI number — WILLIAM F. FLYNN JR. MD PC

Table of content: (NPI 1023209186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023209186 NPI number — WILLIAM F. FLYNN JR. MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM F. FLYNN JR. MD 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:
Provider Other Organization Name Type Code:
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:
1023209186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 MILL ST
Provider Second Line Business Mailing Address:
# 301
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02476-4784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-643-6313
Provider Business Mailing Address Fax Number:
781-643-6316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 MILL ST
Provider Second Line Business Practice Location Address:
# 301
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02476-4784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-643-6313
Provider Business Practice Location Address Fax Number:
781-643-6316
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLYNN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-643-6313

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  32293 , 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: 0141291 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M13029 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9721851 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032293 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17-00465 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8477 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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