1114236114 NPI number — MS. MARY O'BRIEN RODOWICZ RD, LDN

Table of content: MS. MARY O'BRIEN RODOWICZ RD, LDN (NPI 1114236114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114236114 NPI number — MS. MARY O'BRIEN RODOWICZ RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODOWICZ
Provider First Name:
MARY
Provider Middle Name:
O'BRIEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'BRIEN
Provider Other First Name:
MARY
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114236114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEEDS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01053-9764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-582-3005
Provider Business Mailing Address Fax Number:
413-582-3121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEEDS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01053-9764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-582-3005
Provider Business Practice Location Address Fax Number:
413-582-3121
Provider Enumeration Date:
09/26/2010

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: 133V00000X , with the licence number:  769 , 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)





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