1891914511 NPI number — MS. CARALEE OSGOOD PHYSICIAN ASSISTANT

Table of content: MS. CARALEE OSGOOD PHYSICIAN ASSISTANT (NPI 1891914511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891914511 NPI number — MS. CARALEE OSGOOD PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSGOOD
Provider First Name:
CARALEE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSEN
Provider Other First Name:
CARALEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891914511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MAIN STREET
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-396-4514
Provider Business Mailing Address Fax Number:
781-395-4778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MAIN STREET
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-396-4514
Provider Business Practice Location Address Fax Number:
781-395-4778
Provider Enumeration Date:
04/24/2007

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: 363AM0700X , with the licence number:  0598 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA2028 , 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)





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