1467675033 NPI number — DR JOHN E CALLINAN OD PC

Table of content: (NPI 1467675033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467675033 NPI number — DR JOHN E CALLINAN OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOHN E CALLINAN OD PC
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:
1467675033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 CONCORD STREET
Provider Second Line Business Mailing Address:
5 ARCADE
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-875-7662
Provider Business Mailing Address Fax Number:
508-875-7662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 CONCORD STREET
Provider Second Line Business Practice Location Address:
5 ARCADE
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-875-7662
Provider Business Practice Location Address Fax Number:
508-875-7662
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CALLINAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-875-7662

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD2111 , 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: 6000000003 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410018810 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0021770 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9731229 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0315931 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135934 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: W20015 . This is a "BLUE CROSS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15511 . This is a "BLUE CROSS PROV #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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