1003067968 NPI number — ANNA PEABODY SWEENEY MS. RD, LDN

Table of content: ANNA PEABODY SWEENEY MS. RD, LDN (NPI 1003067968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003067968 NPI number — ANNA PEABODY SWEENEY MS. RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEENEY
Provider First Name:
ANNA
Provider Middle Name:
PEABODY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS. RD, LDN
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:
1003067968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 CRESCENT ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02453-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-273-1749
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
78 JUNCTION SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-273-1749
Provider Business Practice Location Address Fax Number:
978-246-0227
Provider Enumeration Date:
10/08/2008

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com