1760540462 NPI number — DEBORAH DIAMOND D.C.

Table of content: DEBORAH DIAMOND D.C. (NPI 1760540462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760540462 NPI number — DEBORAH DIAMOND D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAMOND
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDBERG
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
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:
1760540462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 GREAT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-263-5182
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
274 GREAT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ACTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01720-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-263-5182
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2006

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: 111N00000X , with the licence number:  2742 , 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: AA10989 . This is a "HARVARD PILGRIM ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3116916 . This is a "AETNA ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y36902 . This is a "BLUE CROSS OF MA ID NUMBE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 462097 . This is a "TUFTS ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 676910 . This is a "CIGNA ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0047190 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1600516 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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