1841231909 NPI number — DR. MEVELYN MICHELLE MORSE DPM

Table of content: DR. MEVELYN MICHELLE MORSE DPM (NPI 1841231909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841231909 NPI number — DR. MEVELYN MICHELLE MORSE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORSE
Provider First Name:
MEVELYN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1841231909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 HEMINGWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06512-2384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-466-1410
Provider Business Mailing Address Fax Number:
203-466-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 HEMINGWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06512-2384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-466-1410
Provider Business Practice Location Address Fax Number:
203-466-6410
Provider Enumeration Date:
06/09/2006

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: 213ES0103X , with the licence number:  000802 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 030000802.CT01 . This is a "ANTHEM BCBS PROVIDER ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V7079 . This is a "PHS PROVIDER ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3820734 . This is a "AETNA PROVIDER ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5732109 . This is a "CIGNA PROVIDER ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P00236321 . This is a "RR MEDICARE PROVIDER ID #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3647484 . This is a "OXFORD HEALTHPLANS PROVID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".