1083681563 NPI number — DR. SUSAN D BLOCK MD

Table of content: DR. SUSAN D BLOCK MD (NPI 1083681563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083681563 NPI number — DR. SUSAN D BLOCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOCK
Provider First Name:
SUSAN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
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:
1083681563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BINNEY ST
Provider Second Line Business Mailing Address:
SW411
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-632-6181
Provider Business Mailing Address Fax Number:
617-632-6180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BINNEY ST
Provider Second Line Business Practice Location Address:
SW411
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-6013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-6181
Provider Business Practice Location Address Fax Number:
617-632-6180
Provider Enumeration Date:
03/03/2006

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: 2084P0800X , with the licence number:  43420 , 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)

  • Identifier: 2488260 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: V05389 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: V05389 . This is a "BC ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 702287 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260038158 . This is a "RR MEDICARE DFCI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 154534 . This is a "HPHC DFCI ONLY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260038156 . This is a "RR MEDICARE BINNEY MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: V05389 . This is a "INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0163996 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: V05389 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65517 . This is a "FALLON COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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