1629362983 NPI number — LINDSAY OLIVER M.D.

Table of content: LINDSAY OLIVER M.D. (NPI 1629362983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629362983 NPI number — LINDSAY OLIVER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVER
Provider First Name:
LINDSAY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1629362983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2019
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 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:
508-368-5532
Provider Business Mailing Address Fax Number:
508-832-5751

Provider's Practice Location Mailing Address

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:
508-832-5917
Provider Business Practice Location Address Fax Number:
508-832-5751
Provider Enumeration Date:
06/04/2011

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: 208000000X , with the licence number:  248585 , 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: 110098409A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".