1356365100 NPI number — DR. SAMIR PATEL M.D.

Table of content: DR. SAMIR PATEL M.D. (NPI 1356365100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356365100 NPI number — DR. SAMIR PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
SAMIR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1356365100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
163 LIBBEY INDUSTRIAL PKWY
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02189-3137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-337-4224
Provider Business Mailing Address Fax Number:
781-335-0429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 LIBBEY INDUSTRIAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02189-3137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-337-4224
Provider Business Practice Location Address Fax Number:
781-335-0429
Provider Enumeration Date:
07/26/2006

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: 207L00000X , with the licence number:  157094 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LC0200X , with the licence number: 157094 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 42738 . This is a "HEALTHY START" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00180972 . This is a "PALMETTO GBA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 277311 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: G53914 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 157094 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3187578 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39955 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J19030 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com