1063424380 NPI number — VALLEY PATHOLOGY ASSOCIATES

Table of content: (NPI 1063424380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063424380 NPI number — VALLEY PATHOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY PATHOLOGY ASSOCIATES
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:
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:
1063424380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 BELMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRATTLEBORO
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05301-6613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-257-8372
Provider Business Mailing Address Fax Number:
802-257-8287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 BELMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRATTLEBORO
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05301-6613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-257-8372
Provider Business Practice Location Address Fax Number:
802-257-8287
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
APPLETON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
802-257-8372

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  032-506 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1002078 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 727548 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223355 . This is a "BC/BS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30004664 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00005167 . This is a "BC/BS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 8001047 . This is a "LADIES FIRST" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com