1053322925 NPI number — DENNIS W MAKI MD

Table of content: DENNIS W MAKI MD (NPI 1053322925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053322925 NPI number — DENNIS W MAKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKI
Provider First Name:
DENNIS
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1053322925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 415348
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-5348
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:
55 LAKE AVE N
Provider Second Line Business Practice Location Address:
ACC BUILDING DEPT OF CARDIOLOGY
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01655-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-334-3452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2006

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: 207RC0000X , with the licence number:  39744 , 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: 2069628 . This is a "WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4065786 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28010 . This is a "CHILDRENS MED SECURITY PL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 28010 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: N01811 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4065786 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9900080 . This is a "FALLON COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "HEALTHCARE VALUE MGMT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 784048 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9526220 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA2360 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060056682 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2069628 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 917934 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: N01811 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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