1942382635 NPI number — DR. COLIN A SIEFF MB, BCH

Table of content: DR. COLIN A SIEFF MB, BCH (NPI 1942382635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942382635 NPI number — DR. COLIN A SIEFF MB, BCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEFF
Provider First Name:
COLIN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MB, BCH
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:
1942382635
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:
45 ORCHARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WABAN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02468-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-527-1417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
FEGAN 7
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-258-5228
Provider Business Practice Location Address Fax Number:
617-258-6768
Provider Enumeration Date:
10/20/2006

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: 2080P0207X , with the licence number:  73641 , 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: 3087440 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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