1407962525 NPI number — DR. OTTO TODOROV DC

Table of content: DR. OTTO TODOROV DC (NPI 1407962525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407962525 NPI number — DR. OTTO TODOROV DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TODOROV
Provider First Name:
OTTO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1407962525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 35
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02492-2599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-605-2429
Provider Business Mailing Address Fax Number:
781-444-7427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 35
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02492-2599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-605-2429
Provider Business Practice Location Address Fax Number:
781-444-7427
Provider Enumeration Date:
08/22/2006

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: 111N00000X , with the licence number:  MA1076 , 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: Y35756 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 35450 . This is a "HARVARDPILGRIM HC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 761746 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1607847 . This is a "MASSHEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 288140 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 481021 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4400166 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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