1760483093 NPI number — MR. WILLIAM ROBERT CAMBRIDGE MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760483093 NPI number — MR. WILLIAM ROBERT CAMBRIDGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMBRIDGE
Provider First Name:
WILLIAM
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1760483093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
10/22/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 1/2 CASE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-886-8345
Provider Business Mailing Address Fax Number:
860-886-4251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 1/2 CASE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-886-8345
Provider Business Practice Location Address Fax Number:
860-886-4251
Provider Enumeration Date:
08/09/2005

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: 207X00000X , with the licence number:  023709 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001237098 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010023709CT01 . This is a "ANTHEM BCBS ID NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NLP012 . This is a "OXFORD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 506137 . This is a "AETNA ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030918 . This is a "HEALTHNET ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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