1750330692 NPI number — DR LEE S CASPER ASOOCIATES P. C.

Table of content: (NPI 1750330692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750330692 NPI number — DR LEE S CASPER ASOOCIATES P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR LEE S CASPER ASOOCIATES 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:
1750330692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 QUINCY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02302-2926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-584-6400
Provider Business Mailing Address Fax Number:
508-584-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 QUINCY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02302-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-584-6400
Provider Business Practice Location Address Fax Number:
508-584-6410
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASPER
Authorized Official First Name:
LEE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-584-6400

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1406 , 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: 9726578 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com