1972679686 NPI number — DR. MARJORIE C HEPPNER PHD

Table of content: DR. MARJORIE C HEPPNER PHD (NPI 1972679686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972679686 NPI number — DR. MARJORIE C HEPPNER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEPPNER
Provider First Name:
MARJORIE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1972679686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 TEN ROD RD
Provider Second Line Business Mailing Address:
MEADOWS OFFICE PARK SUITE D205A
Provider Business Mailing Address City Name:
NORTH KINGSTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02852-4158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-295-5320
Provider Business Mailing Address Fax Number:
401-295-5320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 TEN ROD RD
Provider Second Line Business Practice Location Address:
MEADOWS OFFICE PARK SUITE D205A
Provider Business Practice Location Address City Name:
NORTH KINGSTOWN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02852-4158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-295-5320
Provider Business Practice Location Address Fax Number:
401-295-5320
Provider Enumeration Date:
11/27/2006

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: 103T00000X , with the licence number:  PS00378 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 93404 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com