1124020730 NPI number — GENTRY W THATCHER MD

Table of content: GENTRY W THATCHER MD (NPI 1124020730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124020730 NPI number — GENTRY W THATCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THATCHER
Provider First Name:
GENTRY
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1124020730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
198 MASSACHUSETTS AVE #103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-685-7550
Provider Business Mailing Address Fax Number:
978-686-5565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
198 MASSACHUSETTS AVE #103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-685-7550
Provider Business Practice Location Address Fax Number:
978-686-5565
Provider Enumeration Date:
08/12/2005

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: 207Y00000X , with the licence number:  204712 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , with the licence number: 11012 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2344337 . This is a "AETNA/USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: B20973001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0020548 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01Y002475MA01 . This is a "NH BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204712 . This is a "SECURE HORIZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7439118-001 . This is a "CIGNA PAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76754 . This is a "AAO/HNS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 976854 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22387 . This is a "BS-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10-00243 . This is a "UNITED HC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22387 . This is a "BS/MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0104914 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19901 . This is a "H/PIL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65475 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040015652 . This is a "MC RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204712 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com