1669577664 NPI number — DR. MELONIE SUZANNE MARPLE AUD, CCC-A

Table of content: DR. MELONIE SUZANNE MARPLE AUD, CCC-A (NPI 1669577664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669577664 NPI number — DR. MELONIE SUZANNE MARPLE AUD, CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARPLE
Provider First Name:
MELONIE
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD, CCC-A
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:
1669577664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01890-1961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-218-2225
Provider Business Mailing Address Fax Number:
781-218-2226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
955 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01890-1961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-218-2225
Provider Business Practice Location Address Fax Number:
781-218-2226
Provider Enumeration Date:
09/14/2006

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: 231H00000X , with the licence number:  712 , 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: AD0042 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA112373 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 469946 . This is a "TUFTS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 260374608 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5104190 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163914 . This is a "EVERCARE GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 260375608 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".