1528265865 NPI number — DOCTORS COATES AND RIEUR PC

Table of content: (NPI 1528265865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528265865 NPI number — DOCTORS COATES AND RIEUR PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS COATES AND RIEUR 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:
6
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:
1528265865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 BEACON ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-731-9234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1693 BEACON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02445-4494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-731-9155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIEUR
Authorized Official First Name:
HARLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-731-9155

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  MA953 , 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: AA2916 . This is a "HARVARD PILGRIM PROV. ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36942 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 460286 . This is a "TUFTS PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y35652 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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