1588645220 NPI number — MRS. GAIL A OTOOLE ANP

Table of content: MRS. GAIL A OTOOLE ANP (NPI 1588645220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588645220 NPI number — MRS. GAIL A OTOOLE ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTOOLE
Provider First Name:
GAIL
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
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:
1588645220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 LIBBEY PKWY
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02189-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-335-9700
Provider Business Mailing Address Fax Number:
781-335-9709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 LIBBEY PKWY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02189-3129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-335-9700
Provider Business Practice Location Address Fax Number:
781-335-9709
Provider Enumeration Date:
11/09/2005

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: 363LA2200X , with the licence number:  148056 , 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: NP1431 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0340880 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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