1013962026 NPI number — JUDITH A MCNICHOLAS MD

Table of content: JUDITH A MCNICHOLAS MD (NPI 1013962026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013962026 NPI number — JUDITH A MCNICHOLAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNICHOLAS
Provider First Name:
JUDITH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1013962026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 PLANTATION STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-871-0700
Provider Business Mailing Address Fax Number:
508-616-4411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01581-5408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-871-0700
Provider Business Practice Location Address Fax Number:
508-616-4411
Provider Enumeration Date:
05/24/2006

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: 207VF0040X , with the licence number:  76652 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 76652 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1060988 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: J13545 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: J13545 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5070604 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J13545 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110052917A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406954 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784221 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28030 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3212073 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9901002 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28030 . This is a "CHILDRENS MED SECURITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA6366 . This is a "HARVARD PILGRIM HLTHCARE" identifier . This identifiers is of the category "OTHER".




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