1205900560 NPI number — PERRY R HEARN

Table of content: (NPI 1205900560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205900560 NPI number — PERRY R HEARN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRY R HEARN
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:
NORWELL FAMILY MEDICINE
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:
1205900560
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 1770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-212-9600
Provider Business Mailing Address Fax Number:
603-212-9601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 LONGWATER CIR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
NORWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02061-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-659-1800
Provider Business Practice Location Address Fax Number:
781-659-7221
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEARN
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
781-659-1800

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9783784 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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