1083626907 NPI number — ANN-CHRISTINE DUHAIME M.D.

Table of content: ANN-CHRISTINE DUHAIME M.D. (NPI 1083626907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083626907 NPI number — ANN-CHRISTINE DUHAIME M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUHAIME
Provider First Name:
ANN-CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1083626907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 FRUIT ST # 331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-643-9175
Provider Business Mailing Address Fax Number:
617-726-1866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 FRUIT ST # 331
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-643-9175
Provider Business Practice Location Address Fax Number:
617-724-1866
Provider Enumeration Date:
08/12/2006

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: 207T00000X , with the licence number:  245705 , 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: 1008158 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30201711 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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