1881654135 NPI number — MARY G PEARSON DO

Table of content: MARY G PEARSON DO (NPI 1881654135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881654135 NPI number — MARY G PEARSON DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
MARY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1881654135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 ROUTE 125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03848-3535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-642-6700
Provider Business Mailing Address Fax Number:
603-642-6701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 ROUTE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03848-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-642-6700
Provider Business Practice Location Address Fax Number:
603-642-6701
Provider Enumeration Date:
03/23/2006

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: 207Q00000X , with the licence number:  9106 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 76376 , 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: 40226429 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 723885 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4480241 . This is a "AETNA PPO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0402142YPNH01 . This is a "BCBS NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3084720 . This is a "AETNA HMO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 15221 . This is a "CIGNA NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: B10383301 . This is a "CIGNA MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3119076 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F30970 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J12643 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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