1376532275 NPI number — DR. DANIEL HUNTER ERVIN DO

Table of content: KANZA AHMED MD (NPI 1285364539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376532275 NPI number — DR. DANIEL HUNTER ERVIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERVIN
Provider First Name:
DANIEL
Provider Middle Name:
HUNTER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1376532275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01473-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-874-7368
Provider Business Mailing Address Fax Number:
978-874-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01473-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-874-7368
Provider Business Practice Location Address Fax Number:
978-874-6111
Provider Enumeration Date:
10/14/2005

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: 207Y00000X , with the licence number:  80887 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208200000X , with the licence number: 80887 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , 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: 19508 . This is a "HARVARD / PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003021 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 986254 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3256567 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35219192 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3140245 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J16123 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 23782 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 291708409 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0034554 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080887 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00079664 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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