1235107970 NPI number — PROF. BLAIR J MAEROWITZ PA-C

Table of content: PROF. BLAIR J MAEROWITZ PA-C (NPI 1235107970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235107970 NPI number — PROF. BLAIR J MAEROWITZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAEROWITZ
Provider First Name:
BLAIR
Provider Middle Name:
J
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1235107970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29B COTTAGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01002-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-754-3823
Provider Business Mailing Address Fax Number:
508-753-0151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 COTTAGE STREET
Provider Second Line Business Practice Location Address:
B (PIONEER VALLEY DERMATOLOGY)
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-406-3250
Provider Business Practice Location Address Fax Number:
413-549-7402
Provider Enumeration Date:
03/09/2006

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: 363A00000X , with the licence number:  1521 , 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: 9700340 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290001521MA01 . This is a "ANTHEM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 114411681 . This is a "GROUP NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".