1376573501 NPI number — ROGER A. POMPEO, MD

Table of content: (NPI 1376573501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376573501 NPI number — ROGER A. POMPEO, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER A. POMPEO, MD
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:
1376573501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PARKINGWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COHASSET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02025-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-383-9422
Provider Business Mailing Address Fax Number:
781-383-8024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PARKINGWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COHASSET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02025-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-383-9422
Provider Business Practice Location Address Fax Number:
781-383-8024
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POMPEO
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
781-383-9422

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 706228 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M19205 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com