1588730899 NPI number — ORTHOPEDIC TRAUMA P.C.

Table of content: RACHEL JOANNA BERRY MS, PA (NPI 1093320442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588730899 NPI number — ORTHOPEDIC TRAUMA P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC TRAUMA P.C.
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:
1588730899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 TRAPELO RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-7333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-647-3790
Provider Business Mailing Address Fax Number:
781-647-3494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HIGHLAND ST
Provider Second Line Business Practice Location Address:
SUITE G1
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02186-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-696-2300
Provider Business Practice Location Address Fax Number:
617-698-7542
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITELAW
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-698-7542

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9723901 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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