1306977996 NPI number — AASP ALLERGY & ASTHMA SPECIALTY PHYSICIANS, PC

Table of content: (NPI 1306977996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306977996 NPI number — AASP ALLERGY & ASTHMA SPECIALTY PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AASP ALLERGY & ASTHMA SPECIALTY PHYSICIANS, PC
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:
1306977996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 380
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-3441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-769-9045
Provider Business Mailing Address Fax Number:
781-769-0420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 380
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062-3441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-769-9045
Provider Business Practice Location Address Fax Number:
781-769-0420
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAIDA
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-769-9045

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9758852 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M14928 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 711729 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CM2966 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com