1144383472 NPI number — DR. JOAN MARIE EXFORD OD

Table of content: DR. JOAN MARIE EXFORD OD (NPI 1144383472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144383472 NPI number — DR. JOAN MARIE EXFORD OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EXFORD
Provider First Name:
JOAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KORB
Provider Other First Name:
JOAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144383472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 COMMONWEALTH AVE
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-426-0370
Provider Business Mailing Address Fax Number:
617-426-4924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-426-0370
Provider Business Practice Location Address Fax Number:
617-426-4924
Provider Enumeration Date:
12/18/2006

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: 152W00000X , with the licence number:  2129 , 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: 152088 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2257205 . This is a "AETNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W16072 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0308714 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2200596 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 759106 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042304182 . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2129 . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39436002 . This is a "DAVIS VISION EYECARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com