1215998372 NPI number — DR. MICHAEL MCINERNEY M.D.

Table of content: DR. MICHAEL MCINERNEY M.D. (NPI 1215998372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215998372 NPI number — DR. MICHAEL MCINERNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINERNEY
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1215998372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 NORTH ST
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-4147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-499-8510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-499-8510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2006

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:  52752 , 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: 043531502 . This is a "NORTH AMERICAN HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 14302 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043531502 . This is a "CIGNA INDEMNITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3009122 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01673014 . This is a "01673014" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 346303 . This is a "MVP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000020928 . This is a "HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043531502 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 052752 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3871912 . This is a "CIGNA/HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A57070 . This is a "HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043531502 . This is a "HMC PPO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043531502 . This is a "UHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J03573 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043531502 . This is a "GIC INDEMNITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10034389 . This is a "CDCHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110213857 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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