1902036528 NPI number — STEVEN M REPPERT M.D.

Table of content: STEVEN M REPPERT M.D. (NPI 1902036528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902036528 NPI number — STEVEN M REPPERT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REPPERT
Provider First Name:
STEVEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1902036528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
364 PLANTATION ST
Provider Second Line Business Mailing Address:
LRB728
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-4321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-856-6148
Provider Business Mailing Address Fax Number:
508-856-6233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 PLANTATION ST
Provider Second Line Business Practice Location Address:
LRB728
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-856-6148
Provider Business Practice Location Address Fax Number:
508-856-6233
Provider Enumeration Date:
07/16/2009

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: 1744R1102X , with the licence number:  39414 , 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: 208000000X . This is a "NOT INVOVLED WITH DIRECT OR INDIRECT PATIENT CARE IN MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com