1063635456 NPI number — READING INTERNAL MEDICINE ASSOCIATES INC

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 1063635456 NPI number — READING INTERNAL MEDICINE ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
READING INTERNAL MEDICINE ASSOCIATES INC
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:
1063635456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PONDMEADOW DR
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01867-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-944-0040
Provider Business Mailing Address Fax Number:
781-944-1684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 POND MEADOW DR
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-944-0040
Provider Business Practice Location Address Fax Number:
781-944-1684
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRYJMA
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
781-944-0040

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110070324 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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