1366416109 NPI number — DR. ALEXIS-ANN BUNDSCHUH MD

Table of content: DR. ALEXIS-ANN BUNDSCHUH MD (NPI 1366416109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366416109 NPI number — DR. ALEXIS-ANN BUNDSCHUH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNDSCHUH
Provider First Name:
ALEXIS-ANN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1366416109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MAIN ST STE 210A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-2920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-577-3080
Provider Business Mailing Address Fax Number:
603-577-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MAIN ST STE 210A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-577-3080
Provider Business Practice Location Address Fax Number:
603-577-3081
Provider Enumeration Date:
02/16/2006

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: 207R00000X , with the licence number:  6872 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00000023 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: E16957 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0101607YPNH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1412776 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3113242003 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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