1578604401 NPI number — MS. GAEL A EVANGELISTA-UHL NP

Table of content: MS. GAEL A EVANGELISTA-UHL NP (NPI 1578604401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578604401 NPI number — MS. GAEL A EVANGELISTA-UHL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANGELISTA-UHL
Provider First Name:
GAEL
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

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:
1578604401
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:
73 SEARS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01772-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-485-7788
Provider Business Mailing Address Fax Number:
508-485-2777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-726-2217
Provider Business Practice Location Address Fax Number:
617-724-3944
Provider Enumeration Date:
02/12/2007

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: 163WX0106X , with the licence number:  165083 , 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)





Copyright © 2007-2025 www.npivalidator.com