1073574042 NPI number — DARYL G COLDEN M.D.

Table of content: DARYL G COLDEN M.D. (NPI 1073574042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073574042 NPI number — DARYL G COLDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLDEN
Provider First Name:
DARYL
Provider Middle Name:
G
Provider Name Prefix Text:
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:
1073574042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WALLACE BASHAW JR WAY
Provider Second Line Business Mailing Address:
STE 3002
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-997-1550
Provider Business Mailing Address Fax Number:
978-997-1552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WALLACE BASHAW JR WAY
Provider Second Line Business Practice Location Address:
STE 3002
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-997-1550
Provider Business Practice Location Address Fax Number:
978-997-1552
Provider Enumeration Date:
03/30/2006

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: 207YX0905X , with the licence number:  208834 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 208834 , 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: J24800 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 01Y003843MA03 . This is a "ANTHEM NH" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 30204061 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9785370 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00460150 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 59186 . This is a "FALLON COMMUNITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0026698 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3143490 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3391910 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10-00490 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19950 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 208834 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000458 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 97625305 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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