1003934597 NPI number — WINMAR PULMONARY ASSOCIATES LTD

Table of content: (NPI 1003934597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003934597 NPI number — WINMAR PULMONARY ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINMAR PULMONARY ASSOCIATES LTD
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:
6
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:
1003934597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W CUMMINGS PARK
Provider Second Line Business Mailing Address:
SUITE#2000
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-6372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-285-2529
Provider Business Mailing Address Fax Number:
888-796-4915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W CUMMINGS PARK
Provider Second Line Business Practice Location Address:
SUITE#2000
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-285-2529
Provider Business Practice Location Address Fax Number:
888-796-4915
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAWEE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-823-0921

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 710758 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 734608 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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