1770649584 NPI number — MICHAEL AYER

Table of content: MICHAEL AYER (NPI 1770649584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770649584 NPI number — MICHAEL AYER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYER
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1770649584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
228 BILLERICA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-250-6170
Provider Business Mailing Address Fax Number:
978-250-6386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 BILLERICA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-250-6170
Provider Business Practice Location Address Fax Number:
978-250-6170
Provider Enumeration Date:
12/28/2006

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:  3485 , 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: 0014544 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8337514-002 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15782 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0313742 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 792481 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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