1912966011 NPI number — ALDEN G GAGNON M.D.

Table of content: ALDEN G GAGNON M.D. (NPI 1912966011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912966011 NPI number — ALDEN G GAGNON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAGNON
Provider First Name:
ALDEN
Provider Middle Name:
G
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:
1912966011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRIMACK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03054-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-673-9411
Provider Business Mailing Address Fax Number:
603-673-9899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 VILLAGE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-256-4121
Provider Business Practice Location Address Fax Number:
978-250-3210
Provider Enumeration Date:
03/20/2006

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: 207R00000X , with the licence number:  29255 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RH0000X , with the licence number: 29255 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 709837 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 99390801 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 60521 . This is a "HEALTHSOURCE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 20696 . This is a "FALLON COMM HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B13017 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30006380 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0130249 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3000077 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 64833 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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