1417127242 NPI number — HAVERHILL FAMILY PRACTICE

Table of content: (NPI 1417127242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417127242 NPI number — HAVERHILL FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVERHILL FAMILY PRACTICE
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:
HAVERHILL FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1417127242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 BROWN ST.
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-521-6555
Provider Business Mailing Address Fax Number:
978-521-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 BROWN ST
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-521-6555
Provider Business Practice Location Address Fax Number:
978-521-1236
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
978-521-6555

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  27679 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X , 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)





Copyright © 2007-2024 www.npivalidator.com