1063536332 NPI number — EMERGENCY ASSOCIATES OF MILTON PC,

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063536332 NPI number — EMERGENCY ASSOCIATES OF MILTON PC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY ASSOCIATES OF MILTON PC,
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:
1063536332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02339-0299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-826-0053
Provider Business Mailing Address Fax Number:
781-826-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 HIGHLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02186-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-826-0053
Provider Business Practice Location Address Fax Number:
781-826-0053
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PAGANELLI
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
781-826-0053

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000021297 . This is a "BOSTON MEDICAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 717671 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007707 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9764461 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3909927 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M15251 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 604427 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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