1265764104 NPI number — DIGESTIVE HEALTH SPECIALISTS, P.C.

Table of content: (NPI 1265764104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265764104 NPI number — DIGESTIVE HEALTH SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE HEALTH SPECIALISTS, P.C.
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:
1265764104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 MEETING HOUSE RD
Provider Second Line Business Mailing Address:
SUITE 6-8
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824-2766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-454-9811
Provider Business Mailing Address Fax Number:
978-221-6245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 MEETING HOUSE RD
Provider Second Line Business Practice Location Address:
SUITE 6-8
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-454-9811
Provider Business Practice Location Address Fax Number:
978-221-6245
Provider Enumeration Date:
02/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DEMETROULAKOS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
978-454-9811

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9765905 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M15374 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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