1427030378 NPI number — RUSSELL W COURNOYER JR. DPM

Table of content: RUSSELL W COURNOYER JR. DPM (NPI 1427030378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427030378 NPI number — RUSSELL W COURNOYER JR. DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COURNOYER
Provider First Name:
RUSSELL
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
DPM
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:
1427030378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 NEPONSET ST FL STREET12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01606-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-856-9181
Provider Business Mailing Address Fax Number:
508-425-6177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 NEPONSET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01606-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-856-9181
Provider Business Practice Location Address Fax Number:
508-425-6177
Provider Enumeration Date:
11/16/2005

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: 213ES0103X , with the licence number:  1767 , 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: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 965657 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480026268 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA2838 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y70847 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y70910 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4886875 . This is a "CIGNA PAL ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9900050 . This is a "FALLON COMMUNITY HLTH PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26734 . This is a "CHILDRENS MED SECURITY PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7042342 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 785949 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26734 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y70910 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y70910 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0362093 . This is a "MEDICAID/WELFARE" identifier . This identifiers is of the category "OTHER".




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