1407949043 NPI number — MS. ELVIRA QUIROGA JOHNSON M.S.,R.D.,C.D.E.,LDN

Table of content: MS. ELVIRA QUIROGA JOHNSON M.S.,R.D.,C.D.E.,LDN (NPI 1407949043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407949043 NPI number — MS. ELVIRA QUIROGA JOHNSON M.S.,R.D.,C.D.E.,LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ELVIRA
Provider Middle Name:
QUIROGA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.,R.D.,C.D.E.,LDN
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:
1407949043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 FLINT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-664-3093
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
NEIGHBORHOOD DIABETES
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-5193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-784-5647
Provider Business Practice Location Address Fax Number:
781-246-1978
Provider Enumeration Date:
10/02/2006

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: 133V00000X , with the licence number:  NU850 , 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: 469779 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: LD0129 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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