1831133289 NPI number — NATALIE V VILISSOVA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831133289 NPI number — NATALIE V VILISSOVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILISSOVA
Provider First Name:
NATALIE
Provider Middle Name:
V
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:
1831133289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 ORNAC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01742-4159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-287-3167
Provider Business Mailing Address Fax Number:
978-287-3391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 ORNAC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-4159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-287-3167
Provider Business Practice Location Address Fax Number:
978-287-3391
Provider Enumeration Date:
06/16/2006

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: 207R00000X , with the licence number:  213773 , 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: AA28347 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3767953 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J28496 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467891 . This is a "TUFTS HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93039 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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