1669455192 NPI number — MICHAEL A THURSBY DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669455192 NPI number — MICHAEL A THURSBY DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

THURSBY

Provider First Name:

MICHAEL

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

M

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:

1669455192

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/11/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

318 WATERMAN AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

EAST PROVIDENCE

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02914-3525

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-438-5950

Provider Business Mailing Address Fax Number:

401-435-2245

Provider First Line Business Practice Location Address:

318 WATERMAN AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

EAST PROVIDENCE

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02914

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-438-5950

Provider Business Practice Location Address Fax Number:

401-435-6700

Provider Enumeration Date:

11/29/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RN0300X , with the licence number:  213316 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RN0300X , with the licence number: 00502 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 110005090A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 110231848 . This is a "RAILROAD MEDI" identifier . This identifiers is of the category "OTHER".
• Identifier: 405620 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 9022203 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000037167 . This is a "BOSTON MEDICAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 459232 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 692775 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
• Identifier: 3100290 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
• Identifier: J25258 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 502 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 7484643 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1305389001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4132 . This is a "NEIGHBORHOOD HLT" identifier . This identifiers is of the category "OTHER".