1750668539 NPI number — MS. ANGELA MARIE FONSECA LADCI CAS

Table of content: MS. ANGELA MARIE FONSECA LADCI CAS (NPI 1750668539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750668539 NPI number — MS. ANGELA MARIE FONSECA LADCI CAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONSECA
Provider First Name:
ANGELA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LADCI CAS
Provider Gender Code:
F

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:
1750668539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
618 TWIN LAKES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALIFAX
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02338-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-294-4123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 WALDECK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORCHESTER CENTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02124-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-265-2636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2011

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: 324500000X , 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)