1477750610 NPI number — MRS. CAROLE ANN SKINNER LICENSE PHYSICAL THE

Table of content: MRS. CAROLE ANN SKINNER LICENSE PHYSICAL THE (NPI 1477750610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477750610 NPI number — MRS. CAROLE ANN SKINNER LICENSE PHYSICAL THE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKINNER
Provider First Name:
CAROLE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSE PHYSICAL THE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIRIANI
Provider Other First Name:
CAROLE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477750610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 GRAPEVINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-863-1387
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 BURLINGTON WOODS
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-270-0222
Provider Business Practice Location Address Fax Number:
781-270-5005
Provider Enumeration Date:
06/29/2007

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: 225200000X , with the licence number:  418 , 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)





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