1710087788 NPI number — DENISE K SNOW WILLIAMS OD

Table of content: DENISE K SNOW WILLIAMS OD (NPI 1710087788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710087788 NPI number — DENISE K SNOW WILLIAMS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNOW WILLIAMS
Provider First Name:
DENISE
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1710087788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 WARREN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANDOLPH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-963-8448
Provider Business Mailing Address Fax Number:
781-963-5289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 WARREN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDOLPH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-963-8448
Provider Business Practice Location Address Fax Number:
781-963-5289
Provider Enumeration Date:
09/22/2006

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: 152W00000X , with the licence number:  3651 , 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: 468944 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0002693 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19316 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331044505 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W16275 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0338150 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152632 . This is a "HARVARD PILGRIM HEALTH PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 331044505 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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