1205839784 NPI number — DR. GAIL B FAYRE M.D.

Table of content: DR. GAIL B FAYRE M.D. (NPI 1205839784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205839784 NPI number — DR. GAIL B FAYRE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAYRE
Provider First Name:
GAIL
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAWYER
Provider Other First Name:
GAIL
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205839784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 MORRILL PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMESBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01913-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-834-8074
Provider Business Mailing Address Fax Number:
978-834-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-3867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-463-1383
Provider Business Practice Location Address Fax Number:
978-463-1386
Provider Enumeration Date:
05/27/2005

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: 207QS0010X , with the licence number:  9687 , 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: 010122729 . This is a "RAILROAD MEDICARE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0106222YPNH01 . This is a "ANTHEM ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: G33728 . This is a "HARVARD PILGRIM ID #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 222594672 . This is a "GREATWEST HEALTHCARE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2139311 . This is a "CIGNA ID #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 222594672 . This is a "PRIVATE HEALTH CARE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3009542 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 371551 . This is a "MVP HEALTHCARE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0106222Y0NH01 . This is a "ANTHEM HFH ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 222594672 . This is a "HEALTH CARE VALUE MANAG#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3016256 . This is a "AETNA ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: H005016 . This is a "TRICARE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 01-04592 . This is a "UNITED HEALTHCARE ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 371552 . This is a "MVP HEALTHCARE HFH ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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