1730679234 NPI number — MR. MATTHEW THOMAS BEALE CPO

Table of content: MR. MATTHEW THOMAS BEALE CPO (NPI 1730679234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730679234 NPI number — MR. MATTHEW THOMAS BEALE CPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEALE
Provider First Name:
MATTHEW
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CPO
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:
1730679234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1084 N EL CAMINO REAL STE B
Provider Second Line Business Mailing Address:
#122
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-407-6904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 PORTLAND ST
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-996-9058
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2018

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: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PS61292556 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH PROSTHETIST LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CPO03996 . This is a "AMERICAN BOARD FOR CERTIFICATION (ORTHOTICS, PROSTHETICS, PEDORTHICS" identifier . This identifiers is of the category "OTHER".
  • Identifier: OI61292553 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH ORTHOTIST LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com