1659576775 NPI number — MR. PETER LICCARDI PETER LICCARDI

Table of content: MR. PETER LICCARDI PETER LICCARDI (NPI 1659576775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659576775 NPI number — MR. PETER LICCARDI PETER LICCARDI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LICCARDI
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PETER LICCARDI
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LICCARDI
Provider Other First Name:
PETER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PETER LICCARDI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659576775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 JAFFARIAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01830-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-372-2545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 HAVERHILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMESBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01913-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-834-0014
Provider Business Practice Location Address Fax Number:
978-834-9820
Provider Enumeration Date:
06/19/2007

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: 183500000X , with the licence number:  18750 , 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)





Copyright © 2007-2024 www.npivalidator.com