1457333148 NPI number — SANDRA M NAGLER, M.D., P.C

Table of content: (NPI 1457333148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457333148 NPI number — SANDRA M NAGLER, M.D., P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDRA M NAGLER, M.D., P.C
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:
NORTHERN MIDDLESEX WOMENS HEALTHCARE
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:
1457333148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 MAIN ST
Provider Second Line Business Mailing Address:
STE 3B
Provider Business Mailing Address City Name:
NORTH READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01864-2286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-664-5979
Provider Business Mailing Address Fax Number:
978-664-0689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 MAIN ST
Provider Second Line Business Practice Location Address:
3B
Provider Business Practice Location Address City Name:
NORTH READING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01864-2286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-664-5979
Provider Business Practice Location Address Fax Number:
978-664-0689
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NAGLER
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-664-5979

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  81409 , 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: 9783369 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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