1518918598 NPI number — OKSANA PRIMMER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518918598 NPI number — OKSANA PRIMMER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PRIMMER

Provider First Name:

OKSANA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

ROGERSON

Provider Other First Name:

OKSANA

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MD

Provider Other Last Name Type Code:

1

NPI Number:

1518918598

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/14/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5 NEPONSET ST FL STREET2

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:

508-721-1170

Provider Business Mailing Address Fax Number:

508-832-0859

Provider First Line Business Practice Location Address:

385 SOUTHBRIDGE ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

AUBURN

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01501-2498

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-721-1170

Provider Business Practice Location Address Fax Number:

508-832-0859

Provider Enumeration Date:

05/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  220575 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 1667164 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 0407079 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 784178 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 419318 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 91200 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: J28269 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2080796 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7339615 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: AA16904 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
• Identifier: J28269 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: J28269 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".