1982900536 NPI number — MRS. GAIL ELAINE HURLEY-GOODSON PA-C, MHS

Table of content: MRS. GAIL ELAINE HURLEY-GOODSON PA-C, MHS (NPI 1982900536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982900536 NPI number — MRS. GAIL ELAINE HURLEY-GOODSON PA-C, MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURLEY-GOODSON
Provider First Name:
GAIL
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C, MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HURLEY
Provider Other First Name:
GAIL
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C, MHS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982900536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 MALL RD
Provider Second Line Business Mailing Address:
LAHEY HOSPITAL AND MEDICAL CENTER
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01805-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-744-7000
Provider Business Mailing Address Fax Number:
781-744-7516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 MALL RD
Provider Second Line Business Practice Location Address:
LAHEY HOSPITAL AND MEDICAL CENTER
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01805-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-744-7000
Provider Business Practice Location Address Fax Number:
781-744-7516
Provider Enumeration Date:
01/31/2011

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: 363AM0700X , with the licence number:  0887 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA4068 , 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)