1427044528 NPI number — DR. JENNIFER SOUTHER MD

Table of content: DR. JENNIFER SOUTHER MD (NPI 1427044528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427044528 NPI number — DR. JENNIFER SOUTHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUTHER
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1427044528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MARTIN STREET
Provider Second Line Business Mailing Address:
UNIT #30A
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02864-5321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-334-4500
Provider Business Mailing Address Fax Number:
401-312-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MARTIN STREET
Provider Second Line Business Practice Location Address:
UNIT #30A
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02864-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-334-4500
Provider Business Practice Location Address Fax Number:
401-312-0096
Provider Enumeration Date:
09/23/2005

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: 207Q00000X , with the licence number:  MD10848 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01-02493 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: P12001018 . This is a "MULTIPLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 409677 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 320874 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: RI2966 . This is a "ACHS NON-PAR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AA242 . This is a "HARVARD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7133474 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7468665 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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