1275044091 NPI number — MARY CHRISTINE TARMINA-D'ANGELO

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 1275044091 NPI number — MARY CHRISTINE TARMINA-D'ANGELO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARMINA-D'ANGELO
Provider First Name:
MARY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
D'ANGELO
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275044091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 HARTFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02052-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-359-2810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 FOREST STREET
Provider Second Line Business Practice Location Address:
HOLLISTER HALL, 1ST FLOOR
Provider Business Practice Location Address City Name:
BABSON PARK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02457-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-239-6363
Provider Business Practice Location Address Fax Number:
781-239-5069
Provider Enumeration Date:
10/19/2017

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: 163WC1400X , with the licence number:  RN186122 , 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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