1679555809 NPI number — AMY ELIZABETH LECOMTE MD

Table of content: AMY ELIZABETH LECOMTE MD (NPI 1679555809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679555809 NPI number — AMY ELIZABETH LECOMTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LECOMTE
Provider First Name:
AMY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
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:
ROSEN
Provider Other First Name:
AMY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679555809
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:
75 FRANCIS ST
Provider Second Line Business Mailing Address:
RADIOLOGY BRIGHAM & WOMENS HOSPITAL
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-6110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-732-6506
Provider Business Mailing Address Fax Number:
617-732-6336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 FRANCIS ST
Provider Second Line Business Practice Location Address:
RADIOLOGY BRIGHAM & WOMENS HOSPITAL
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-732-6506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2005

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: 2085R0202X , with the licence number:  219804 , 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: J27201 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2037408 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 469082 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".