1841266012 NPI number — CHERYL L MARIANO-PERUGINI NP

Table of content: CHERYL L MARIANO-PERUGINI NP (NPI 1841266012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841266012 NPI number — CHERYL L MARIANO-PERUGINI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARIANO-PERUGINI
Provider First Name:
CHERYL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1841266012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 NEPONSET ST FL STREET2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01606-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-368-5532
Provider Business Mailing Address Fax Number:
508-721-9106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 SOUTHBRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01501-2498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-721-1180
Provider Business Practice Location Address Fax Number:
508-721-9106
Provider Enumeration Date:
02/27/2006

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: 363L00000X , with the licence number:  208928 , 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: 042472266 . This is a "PRIVATE HELATHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP1021 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57173 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40682 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA3615 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0701131 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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