1356414205 NPI number — DR. KAREN LORING FRIZZELL LEWIS OD

Table of content: DR. KAREN LORING FRIZZELL LEWIS OD (NPI 1356414205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356414205 NPI number — DR. KAREN LORING FRIZZELL LEWIS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIZZELL LEWIS
Provider First Name:
KAREN
Provider Middle Name:
LORING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
KAREN
Provider Other Middle Name:
LORING
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356414205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-927-3650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 CENTRAL SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-225-2258
Provider Business Practice Location Address Fax Number:
617-497-2025
Provider Enumeration Date:
11/16/2006

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: 152W00000X , with the licence number:  3145 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11456303 . This is a "CAQH CREDENTIALING CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA37222 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 494820 . This is a "TUFTS HEALTHPLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2025036001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 911256 . This is a "EYE MED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0707121 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5029027 . This is a "ATENA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16085 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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