1073630752 NPI number — NEPHROLOGY ASSOCIATES, P. A.

Table of content: (NPI 1073630752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073630752 NPI number — NEPHROLOGY ASSOCIATES, P. A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY ASSOCIATES, P. A.
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:
1073630752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 ELM ST
Provider Second Line Business Mailing Address:
SUITE 201C
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03104-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-641-5800
Provider Business Mailing Address Fax Number:
603-621-4126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 ELM ST
Provider Second Line Business Practice Location Address:
SUITE 201C
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03104-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-641-5800
Provider Business Practice Location Address Fax Number:
603-621-4126
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
603-621-2948

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 81393872 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: RR441391114 . This is a "MEDICARE TRAVELERS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 133 . This is a "CIGNA GROUP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 50Y387200NH01 . This is a "ANTHEM GROUP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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