1093734220 NPI number — GEORGE J CLAIRMONT MD

Table of content: GEORGE J CLAIRMONT MD (NPI 1093734220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093734220 NPI number — GEORGE J CLAIRMONT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAIRMONT
Provider First Name:
GEORGE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1093734220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
362 N BEDFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRIDGEWATER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02333-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-350-2350
Provider Business Mailing Address Fax Number:
508-350-2318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
673 BEDFORD ST
Provider Second Line Business Practice Location Address:
RTE 18
Provider Business Practice Location Address City Name:
ABINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-878-1903
Provider Business Practice Location Address Fax Number:
781-982-0387
Provider Enumeration Date:
07/19/2006

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: 207R00000X , with the licence number:  53790 , 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: CX1704 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J04281 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 61510 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 716367 . This is a "TAHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3195741 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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