1669462818 NPI number — DR. LENA EBBA DOHLMAN MD

Table of content: DR. LENA EBBA DOHLMAN MD (NPI 1669462818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669462818 NPI number — DR. LENA EBBA DOHLMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOHLMAN
Provider First Name:
LENA
Provider Middle Name:
EBBA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOHLMAN-GERHART
Provider Other First Name:
LENA
Provider Other Middle Name:
EBBA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669462818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1493 CAMBRIDGE ST
Provider Second Line Business Mailing Address:
CHA - ANESTHESIOLOGY
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02139-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-499-6634
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1493 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
CHA - ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02139-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-499-6634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2005

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: 207L00000X , with the licence number:  44278 , 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: 3037151 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044278 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J07027 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".