1114097599 NPI number — BRETT S STECKER DO

Table of content: BRETT S STECKER DO (NPI 1114097599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114097599 NPI number — BRETT S STECKER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STECKER
Provider First Name:
BRETT
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1114097599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 PARAMOUNT DR
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
RAYNHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02767-5416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-880-0012
Provider Business Mailing Address Fax Number:
508-880-0256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 PARAMOUNT DR
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
RAYNHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02767-5416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-880-0012
Provider Business Practice Location Address Fax Number:
508-880-0256
Provider Enumeration Date:
11/09/2006

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: 207Q00000X , with the licence number:  215705 , 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: 318796 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 713631 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2097010 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J25682 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 215705 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3796020 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000024762 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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