1285759266 NPI number — LAURENCE S. WOHL, M.D.P.C.

Table of content: (NPI 1285759266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285759266 NPI number — LAURENCE S. WOHL, M.D.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURENCE S. WOHL, M.D.P.C.
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:
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:
1285759266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 QUINCY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02302-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-587-5252
Provider Business Mailing Address Fax Number:
508-427-4318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 QUINCY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02302-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-587-5252
Provider Business Practice Location Address Fax Number:
508-427-4318
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOHL
Authorized Official First Name:
LAURENCE
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
508-587-5252

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34264 , 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: 2032937 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 708384 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: C20209 . This is a "BLUE SHIELD-INDIVIDUAL ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1891749669 . This is a "NPI-INDIVIDUAL ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6055 . This is a "HARVARDPILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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