1043475940 NPI number — MCCARTY ANESTHESIOLOGY, LLC

Table of content: BEVERLY JEAN KLUG LMFT (NPI 1447456777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043475940 NPI number — MCCARTY ANESTHESIOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCARTY ANESTHESIOLOGY, 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:
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:
1043475940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 SOLSTICE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02067-3140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-913-3363
Provider Business Mailing Address Fax Number:
617-945-2314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 SOLSTICE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02067-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-913-3363
Provider Business Practice Location Address Fax Number:
617-945-2314
Provider Enumeration Date:
07/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHUN
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
617-913-3363

Provider Taxonomy Codes

  • Taxonomy code: 1223D0004X , with the licence number:  DN2191520A , 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)





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