1891840138 NPI number — MD MEDICAL WRITING, LLC

Table of content: (NPI 1891840138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891840138 NPI number — MD MEDICAL WRITING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MD MEDICAL WRITING, LLC
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:
SUSAN F BURROUGHS M.D.
Provider Other Organization Name Type Code:
5
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:
1891840138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 PALOMBA DR
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
ENFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06082-3853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-265-2655
Provider Business Mailing Address Fax Number:
860-265-2699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 PALOMBA DR
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-265-2655
Provider Business Practice Location Address Fax Number:
860-265-2699
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BURROUGHS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
FAYE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-265-2655

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  030948 , 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: DF6688 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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