1205825734 NPI number — DR. GAIL RAE ZIMMERMANN WOLFE MD

Table of content: DR. GAIL RAE ZIMMERMANN WOLFE MD (NPI 1205825734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205825734 NPI number — DR. GAIL RAE ZIMMERMANN WOLFE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
GAIL
Provider Middle Name:
RAE ZIMMERMANN
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:
1205825734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/19/2005
NPI Reactivation Date:
09/12/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 W BOULEVARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON CENTRE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02459-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-527-7848
Provider Business Mailing Address Fax Number:
617-562-7853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
CARITA ST ELIZABETHS DEPT OF PATHOLOGY
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-789-2405
Provider Business Practice Location Address Fax Number:
617-562-7853
Provider Enumeration Date:
10/18/2005

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: 207ZP0102X , with the licence number:  45727 , 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)





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