1033109095 NPI number — DANETTE T COLELLA

Table of content: DANETTE T COLELLA (NPI 1033109095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033109095 NPI number — DANETTE T COLELLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLELLA
Provider First Name:
DANETTE
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1033109095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BOULDER POINT DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03264-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-536-4000
Provider Business Mailing Address Fax Number:
603-536-4000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BOULDER POINT DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03264-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-536-4000
Provider Business Practice Location Address Fax Number:
603-536-4000
Provider Enumeration Date:
10/21/2005

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: 208000000X , with the licence number:  159758 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 64573 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 19572 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100051863 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3191664 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710585 . This is a "HVD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7457583 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016422 . This is a "NEIGHBORHOOD HLTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "GREAT WEST HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 42310 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "HCVM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 159758 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B10361201 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "GIC UNICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J19947 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "DOC FIRST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3118251 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com