1114907045 NPI number — LAURA PRICE M.D.

Table of content: LAURA PRICE M.D. (NPI 1114907045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114907045 NPI number — LAURA PRICE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
LAURA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1114907045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 HALL DR
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01002-2751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-253-3773
Provider Business Mailing Address Fax Number:
413-256-0215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HALL DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-253-3773
Provider Business Practice Location Address Fax Number:
413-256-0215
Provider Enumeration Date:
01/18/2006

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: 208000000X , with the licence number:  71719 , 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: 24207 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 01243301 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 202088 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04298 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2374889 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3053105 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 717195 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J09036 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000007636 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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