1114024312 NPI number — BERNARD J DURANTE MD PC

Table of content: (NPI 1114024312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114024312 NPI number — BERNARD J DURANTE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERNARD J DURANTE MD PC
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:
6
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:
1114024312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 ALDRIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-746-8977
Provider Business Mailing Address Fax Number:
508-746-3364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 ALDRIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-746-8977
Provider Business Practice Location Address Fax Number:
508-746-3364
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DURANTE
Authorized Official First Name:
BERANRD
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-746-8977

Provider Taxonomy Codes

  • Taxonomy code: 207KI0005X , with the licence number:  58069 , 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: 9771091 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17916 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 711390 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2652138 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1000029 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19073 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com