1649239757 NPI number — DR. JOHN L ETEN MD

Table of content: DR. JOHN L ETEN MD (NPI 1649239757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649239757 NPI number — DR. JOHN L ETEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETEN
Provider First Name:
JOHN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1649239757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 MAIN ST
Provider Second Line Business Mailing Address:
ORLEANS MEDICAL CENTER, P.C.
Provider Business Mailing Address City Name:
ORLEANS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02653-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-255-8825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 MAIN ST
Provider Second Line Business Practice Location Address:
ORLEANS MEDICAL CENTER, P.C.
Provider Business Practice Location Address City Name:
ORLEANS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02653-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-255-8825
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2006

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: 207Q00000X , with the licence number:  51173 , 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: 01-00821 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6185932 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 723878 . This is a "TUFTS HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: B10436901 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000031977 . This is a "BOSTON MEDICAL HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28599 . This is a "CHILDREN'S MEDICAL SECURI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7725 . This is a "HARVARDPILGRIM HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080130572 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J03410 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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