1851365035 NPI number — PATRICIA ANNE DYKSTRA MD

Table of content: RAISA VALDES MORALES (NPI 1821763707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851365035 NPI number — PATRICIA ANNE DYKSTRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYKSTRA
Provider First Name:
PATRICIA
Provider Middle Name:
ANNE
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:
1851365035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
597 MERRIMACK ST
Provider Second Line Business Mailing Address:
LOWELL COMMUNITY HEALTH CENTER
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-937-9700
Provider Business Mailing Address Fax Number:
978-446-9830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
597 MERRIMACK ST
Provider Second Line Business Practice Location Address:
LOWELL COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-937-9700
Provider Business Practice Location Address Fax Number:
978-446-9830
Provider Enumeration Date:
02/15/2006

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: 208000000X , with the licence number:  77409 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0208X , with the licence number: 77409 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 042881348 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1339 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6469876 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204699 . This is a "HARVARD PILGRIM HLTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9204204 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 731688 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J14028 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22397 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 979892 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3437455 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042881348 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1305557 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042881348 . This is a "CHOICECARE" identifier . This identifiers is of the category "OTHER".




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