1548676877 NPI number — POUNDS, MEDICAL WEIGHT LOSS TRANSFORMATION, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548676877 NPI number — POUNDS, MEDICAL WEIGHT LOSS TRANSFORMATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POUNDS, MEDICAL WEIGHT LOSS TRANSFORMATION, 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:
1548676877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 LASALLE RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06107-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-906-1289
Provider Business Mailing Address Fax Number:
860-906-1269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 LASALLE RD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
WEST HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06107-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-906-1289
Provider Business Practice Location Address Fax Number:
860-906-1269
Provider Enumeration Date:
07/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CAVO
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-906-1289

Provider Taxonomy Codes

  • Taxonomy code: 207VB0002X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D100101600 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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