1598886400 NPI number — WAREHAM WOMENS HEALTH INC

Table of content: MR. SENTORIS BRONNER (NPI 1588158075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598886400 NPI number — WAREHAM WOMENS HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAREHAM WOMENS HEALTH INC
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:
1598886400
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:
191 MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 213C
Provider Business Mailing Address City Name:
WAREHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-295-5595
Provider Business Mailing Address Fax Number:
508-295-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 213C
Provider Business Practice Location Address City Name:
WAREHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-295-5595
Provider Business Practice Location Address Fax Number:
508-295-7767
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RHODES
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
508-295-5595

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  45968 , 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: J04844 . This is a "BCBS GREGORY CHU MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3000931 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215096672 . This is a "NPI WENDY F BONE MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 734962 . This is a "TUFTS GREGORY CHU MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1821195066 . This is a "NPI GREGORY CHU MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 779026 . This is a "TUFTS WENDY F BONE MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J04545 . This is a "BCBS WENDY F BONE MD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6199437 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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