1396903688 NPI number — MS. GAIL PORTER-BECKLEY MA

Table of content: MS. GAIL PORTER-BECKLEY MA (NPI 1396903688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396903688 NPI number — MS. GAIL PORTER-BECKLEY MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTER-BECKLEY
Provider First Name:
GAIL
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PORTER
Provider Other First Name:
GAIL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396903688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 WEST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-9408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-777-6787
Provider Business Mailing Address Fax Number:
802-786-5078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 WEST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-9408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-777-6787
Provider Business Practice Location Address Fax Number:
802-786-5078
Provider Enumeration Date:
05/23/2008

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: 101YM0800X , with the licence number:  0680000198 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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