1124017660 NPI number — CHRISTINA L MOREAU MD

Table of content: CHRISTINA L MOREAU MD (NPI 1124017660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124017660 NPI number — CHRISTINA L MOREAU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOREAU
Provider First Name:
CHRISTINA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1124017660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843013
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:
02284-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-898-7138
Provider Business Mailing Address Fax Number:
616-975-9827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 WHITWELL ST
Provider Second Line Business Practice Location Address:
ATTN EMERGENCY DEPT
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-376-5549
Provider Business Practice Location Address Fax Number:
617-376-5553
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  154085 , 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: #771587 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J17671 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000005223 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3167887 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA101473 . This is a "PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 771587 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 71888 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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