1407823123 NPI number — TOWN OF WAYLAND

Table of content: BRANDON STEWART DPT (NPI 1578399697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407823123 NPI number — TOWN OF WAYLAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF WAYLAND
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:
1407823123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4110, DEPT 5990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01888-4110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-358-6910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 COCHITUATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYLAND
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01778-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-358-6912
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHERSON
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
508-358-6910

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 700480 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800087 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0009526 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 629402 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 030559 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1706993 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590001199 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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