1205834496 NPI number — DR. JUDITH R DARROW OD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205834496 NPI number — DR. JUDITH R DARROW OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARROW
Provider First Name:
JUDITH
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1205834496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4199 WASHINGTON ST UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSLINDALE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02131-1733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-323-7300
Provider Business Mailing Address Fax Number:
781-234-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4199 WASHINGTON ST UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSLINDALE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02131-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-323-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2005

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: 152W00000X , with the licence number:  3566 , 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: 9894 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 759149 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8869163 . This is a "HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W15935 . This is a "BS-BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0356158 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150564 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27366 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 759149 . This is a "TUFTS BENEFITS ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 759149 . This is a "TUFTS SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8669163 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: U12537 . This is a "FIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: W15935 . This is a "HMO BLUE/BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0003271 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150564 . This is a "HARVARD PILGRIM POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150564 . This is a "HARVARD PILGRIM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 759149 . This is a "TUFTS COMMONWEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: W15935 . This is a "BS INDEMNITY" identifier . This identifiers is of the category "OTHER".




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