1205812310 NPI number — GEOFFREY W EMERSON MD

Table of content: GEOFFREY W EMERSON MD (NPI 1205812310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205812310 NPI number — GEOFFREY W EMERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMERSON
Provider First Name:
GEOFFREY
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:
1205812310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WEST STREET
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
S WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02190-1861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-337-2400
Provider Business Mailing Address Fax Number:
781-337-5398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WEST STREET
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
S WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02190-1861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-337-2400
Provider Business Practice Location Address Fax Number:
781-337-5398
Provider Enumeration Date:
12/20/2005

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: 207W00000X , with the licence number:  34519 , 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: 4488236001 . This is a "CIGNA PAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 84248 . This is a "AETNA/USHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 070360047 . This is a "VSP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2045052 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA29363 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0800790 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 729116 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2200775 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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