1235281593 NPI number — DIERDRE ANDERSON AUD

Table of content: DIERDRE ANDERSON AUD (NPI 1235281593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235281593 NPI number — DIERDRE ANDERSON AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
DIERDRE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
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:
1235281593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01952-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-465-5321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01952-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-465-5321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007

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: 231H00000X , with the licence number:  362 , 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: AD0021 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2319512 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5102537 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 468876 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA2241 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3401638 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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