1104114792 NPI number — CAITLIN JULIA MARCHENKO NP

Table of content: CAITLIN JULIA MARCHENKO NP (NPI 1104114792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104114792 NPI number — CAITLIN JULIA MARCHENKO NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCHENKO
Provider First Name:
CAITLIN
Provider Middle Name:
JULIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHADWICK
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
JULIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104114792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 OBERY ST
Provider Second Line Business Mailing Address:
DEPT OF NEUROLOGY AND NEUROSURGERY
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360-2130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-210-5925
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 OBERY ST
Provider Second Line Business Practice Location Address:
DEPT OF NEUROLOGY AND NEUROSURGERY
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-210-5925
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2011

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: 363LF0000X , with the licence number:  282212 , 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)