1255331336 NPI number — DR. JEFFREY PAUL PALMER M.D.

Table of content: DR. JEFFREY PAUL PALMER M.D. (NPI 1255331336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255331336 NPI number — DR. JEFFREY PAUL PALMER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMER
Provider First Name:
JEFFREY
Provider Middle Name:
PAUL
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:
1255331336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 CONWAY ST
Provider Second Line Business Mailing Address:
GREENFIELD HEALTH CENTER
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01301-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-774-6301
Provider Business Mailing Address Fax Number:
413-772-3314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 CONWAY ST
Provider Second Line Business Practice Location Address:
GREENFIELD HEALTH CENTER
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01301-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-774-6301
Provider Business Practice Location Address Fax Number:
413-774-6528
Provider Enumeration Date:
07/29/2005

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: 207Q00000X , with the licence number:  72936 , 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: 2329771 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 24191 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: E76206 . This is a "HARVARD PILGRIM HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J10815 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1293391 . This is a "FALLON COMMUNITY HEALT HPLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000023578 . This is a "BOSTON MEDICAL CENTER HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 491530 . This is a "US FAMILY HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 729361 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 10272501 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2211709 03 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3066118 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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