1851448369 NPI number — KIM CIAMPA-MAGGIO O.D.

Table of content: KIM CIAMPA-MAGGIO O.D. (NPI 1851448369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851448369 NPI number — KIM CIAMPA-MAGGIO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIAMPA-MAGGIO
Provider First Name:
KIM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CIAMPA
Provider Other First Name:
KIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851448369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 BELMONT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELROSE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02176-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-665-5781
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELROSE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02176-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-665-0897
Provider Business Practice Location Address Fax Number:
781-665-8828
Provider Enumeration Date:
01/05/2007

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:  MA 3960 , 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: W16162 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0712833 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9376017 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".