1871675694 NPI number — HEMATOLOGY ONCOLOGY SPECIALISTS OF CAPE COD, P.C.

Table of content: (NPI 1871675694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871675694 NPI number — HEMATOLOGY ONCOLOGY SPECIALISTS OF CAPE COD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY ONCOLOGY SPECIALISTS OF CAPE COD, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1871675694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 JONES RD
Provider Second Line Business Mailing Address:
SUITE 2-5
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02540-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-540-1163
Provider Business Mailing Address Fax Number:
508-540-7550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 JONES RD
Provider Second Line Business Practice Location Address:
SUITE 2-5
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02540-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-540-1163
Provider Business Practice Location Address Fax Number:
508-540-7550
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AVILES
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
508-540-1163

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  210733 , 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: 453027 . This is a "TUFTS INDIV PROV #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: GROUP PROV # PENDING , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J24050 . This is a "BLUE SHIELD OF MA INDIV." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA69996 . This is a "HARVARD PILGRIM HLTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: GROUP # PENDING . This is a "TUFTS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5329445 . This is a "AETNA INDIV PROV #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7881833 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9718309 . This is a "CIGNA INDIV PROV #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M19270 . This is a "BLUE SHIELD OF MA GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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