1154313930 NPI number — RENE WILLIAM AILLON MD

Table of content: RENE WILLIAM AILLON MD (NPI 1154313930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154313930 NPI number — RENE WILLIAM AILLON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AILLON
Provider First Name:
RENE
Provider Middle Name:
WILLIAM
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:
1154313930
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:
BERKSHIRE ANESTHESIOLOGISTS PC
Provider Second Line Business Mailing Address:
100 NORTH STREET SUITE 413
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-447-2555
Provider Business Mailing Address Fax Number:
413-443-7039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BERKSHIRE MEDICAL CENTER
Provider Second Line Business Practice Location Address:
725 NORTH STREET
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-447-2555
Provider Business Practice Location Address Fax Number:
413-443-7039
Provider Enumeration Date:
08/18/2005

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: 207L00000X , with the licence number:  159201 , 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: 3197727 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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