1558343954 NPI number — DR. JACQUELINE J GERMAIN MD

Table of content: DR. JACQUELINE J GERMAIN MD (NPI 1558343954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558343954 NPI number — DR. JACQUELINE J GERMAIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERMAIN
Provider First Name:
JACQUELINE
Provider Middle Name:
J
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:
1558343954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 ROSEMARY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-7027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-326-4159
Provider Business Mailing Address Fax Number:
617-234-7981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
YOUVILLE HOSPITAL
Provider Second Line Business Practice Location Address:
1575 CAMBRIDGE STREET
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-4398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-876-4344
Provider Business Practice Location Address Fax Number:
617-234-7981
Provider Enumeration Date:
11/19/2005

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: 208100000X , with the licence number:  43448 , 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: 6187978 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com