1275519365 NPI number — METHUEN PODIATRY ASSOCIATES LLP

Table of content: (NPI 1275519365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275519365 NPI number — METHUEN PODIATRY ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHUEN PODIATRY ASSOCIATES LLP
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:
1275519365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METHUEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01844-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-682-0382
Provider Business Mailing Address Fax Number:
978-975-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METHUEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01844-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-682-0382
Provider Business Practice Location Address Fax Number:
978-975-3585
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
MARC
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
978-682-0382

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y77357 . This is a "BLUE CROSS OF MASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 119448 . This is a "HEALTH PARTNERS,MULTI PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9756680 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202669700 . This is a "USP DEPART OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 629 . This is a "SENIOR WHOLE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0039719 . This is a "NEIGHBORHOOD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5190491 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: DF6168 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 724027 . This is a "TUFTS HMO.PPO" identifier . This identifiers is of the category "OTHER".




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