1649316969 NPI number — PAUL P. HARASIMOWICZ,III,M.D.,P.C.

Table of content: (NPI 1649316969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649316969 NPI number — PAUL P. HARASIMOWICZ,III,M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL P. HARASIMOWICZ,III,M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1649316969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 GROTON RD
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
AYER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01432-1124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-772-9846
Provider Business Mailing Address Fax Number:
978-772-1180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 GROTON RD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
AYER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01432-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-772-9846
Provider Business Practice Location Address Fax Number:
978-772-1180
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARASIMOWICZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-772-9846

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  73797 , 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: 073797 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9779612 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J11220 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3078272 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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