1942395454 NPI number — AGUSTIN M FLORIAN, MD, PC

Table of content: (NPI 1942395454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942395454 NPI number — AGUSTIN M FLORIAN, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGUSTIN M FLORIAN, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1942395454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE # 115
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-3441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-769-2503
Provider Business Mailing Address Fax Number:
781-769-4696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE # 115
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062-3441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-769-2503
Provider Business Practice Location Address Fax Number:
781-769-4696
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLORIAN
Authorized Official First Name:
AGUSTIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-769-2503

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , 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: 0013607 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M13160 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 26001 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000029169 . This is a "BMC HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 700405 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 18-02000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 441333831 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9723935 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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