1760448450 NPI number — MARY K JOYCE MD

Table of content: MARY K JOYCE MD (NPI 1760448450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760448450 NPI number — MARY K JOYCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOYCE
Provider First Name:
MARY
Provider Middle Name:
K
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:
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:
1760448450
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
289 COUNTY RD
Provider Second Line Business Mailing Address:
MT ASCUTNEY PHYSICIAN PRACTICES
Provider Business Mailing Address City Name:
WINDSOR
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-674-7344
Provider Business Mailing Address Fax Number:
802-674-7314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
289 COUNTY RD
Provider Second Line Business Practice Location Address:
MT ASCUTNEY PHYSICIAN PRACTICES
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-674-7344
Provider Business Practice Location Address Fax Number:
802-674-7314
Provider Enumeration Date:
04/22/2006

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: 207Q00000X , with the licence number:  8165 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 042-0011915 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30003009 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000118 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0105052YPNH01 . This is a "BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P080088013 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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