1972290955 NPI number — DR. SUSANNA OLUWADUNNI AROWOSEGBE

Table of content: DR. SUSANNA OLUWADUNNI AROWOSEGBE (NPI 1972290955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972290955 NPI number — DR. SUSANNA OLUWADUNNI AROWOSEGBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AROWOSEGBE
Provider First Name:
SUSANNA
Provider Middle Name:
OLUWADUNNI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLOFINTUYI
Provider Other First Name:
SUSANNA
Provider Other Middle Name:
OLUWADUNNI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972290955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1132 ARBORETUM WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02021-2737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
529 TIMPANY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01440-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-878-8100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2023

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: 1223G0001X , with the licence number:  DL15618 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DL15884 , 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)