1134118508 NPI number — DR. RENEE M GOETZLER MD

Table of content: DR. RENEE M GOETZLER MD (NPI 1134118508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134118508 NPI number — DR. RENEE M GOETZLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOETZLER
Provider First Name:
RENEE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1134118508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 WORCESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01701-5348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-532-0223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 WORCESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01701-5348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-532-0223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2005

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: 207R00000X , with the licence number:  55352 , 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: 055352 . This is a "TUFTS ASSOCIATED HEALTH P" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B10317401 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 66695 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110165890 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J08461 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0004869 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0401837 . This is a "UNITED HEALTH CARE OF NE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3046737 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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