1063558427 NPI number — DR. MIGUEL ANGEL MARTINEZ M.D.

Table of content: DR. MIGUEL ANGEL MARTINEZ M.D. (NPI 1063558427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063558427 NPI number — DR. MIGUEL ANGEL MARTINEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
MIGUEL
Provider Middle Name:
ANGEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1063558427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 MAPLE ST.
Provider Second Line Business Mailing Address:
LAHEY HEALTH URGENT CARE, DANVERS
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-304-8380
Provider Business Mailing Address Fax Number:
978-304-8389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-4065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-739-1206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

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: 207Q00000X , with the licence number:  51618 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 51618 , 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)





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