1619032372 NPI number — DR. EUGENE LESLIE PACKER D.C.

Table of content: DAYNA RODRIGUEZ COTA (NPI 1013115211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619032372 NPI number — DR. EUGENE LESLIE PACKER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACKER
Provider First Name:
EUGENE
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1619032372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 WASHINGTON ST
Provider Second Line Business Mailing Address:
PO BOX 369
Provider Business Mailing Address City Name:
NORTH EASTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02356-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-238-0183
Provider Business Mailing Address Fax Number:
508-238-3885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH EASTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02356-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-238-0183
Provider Business Practice Location Address Fax Number:
508-238-3885
Provider Enumeration Date:
12/23/2006

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: 111N00000X , with the licence number:  348 , 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: Y35052 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39363 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA135580 . This is a "HARVARD PILIGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 711961 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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