1548602956 NPI number — RYAN JEFFREY TAPPIN RN

Table of content: RYAN JEFFREY TAPPIN RN (NPI 1548602956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548602956 NPI number — RYAN JEFFREY TAPPIN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAPPIN
Provider First Name:
RYAN
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

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:
1548602956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 FEDERAL STREET
Provider Second Line Business Mailing Address:
LAHEY DANVERS
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-774-0730
Provider Business Mailing Address Fax Number:
978-750-0246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 FEDERAL STREET
Provider Second Line Business Practice Location Address:
LAHEY DANVERS
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-774-0730
Provider Business Practice Location Address Fax Number:
978-750-0246
Provider Enumeration Date:
07/26/2013

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: 363L00000X , with the licence number:  RN2277613 , 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: 110097192A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com