1073707121 NPI number — MS. MEGRETTE F FLETCHER RD LD CDE

Table of content: MS. MEGRETTE F FLETCHER RD LD CDE (NPI 1073707121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073707121 NPI number — MS. MEGRETTE F FLETCHER RD LD CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
MEGRETTE
Provider Middle Name:
F
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD LD CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMMOND
Provider Other First Name:
MEGRETTE
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED RD CDE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073707121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
789 CENTRAL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03820-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-742-7222
Provider Business Mailing Address Fax Number:
603-740-7441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MEMBERS WAY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-5933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-742-7222
Provider Business Practice Location Address Fax Number:
603-740-7441
Provider Enumeration Date:
08/31/2007

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: 133V00000X , with the licence number:  803789 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AA130972 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 4657745 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 1073707121 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 9653276 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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