1710962931 NPI number — DR. JOSE MARCHENA DMD,MD

Table of content: DR. JOSE MARCHENA DMD,MD (NPI 1710962931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710962931 NPI number — DR. JOSE MARCHENA DMD,MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCHENA
Provider First Name:
JOSE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD,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:
1710962931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 ESSEX CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-2905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-531-1450
Provider Business Mailing Address Fax Number:
978-531-9984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ESSEX CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-531-1450
Provider Business Practice Location Address Fax Number:
978-531-9984
Provider Enumeration Date:
12/09/2005

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: 1223S0112X , with the licence number:  18790 , 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: 760850 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA69690 . This is a "HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0205273 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA68463 . This is a "HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: X09533 . This is a "BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA65447 . This is a "HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: V06473 . This is a "BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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