1306930011 NPI number — NOEL H OLSEN M.D.,

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 1306930011 NPI number — NOEL H OLSEN M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSEN
Provider First Name:
NOEL
Provider Middle Name:
H
Provider Name Prefix Text:
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:
1306930011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 PRESIDENT AVENUE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-676-3411
Provider Business Mailing Address Fax Number:
508-646-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 PRESIDENT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-676-3411
Provider Business Practice Location Address Fax Number:
508-646-1576
Provider Enumeration Date:
10/03/2006

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: 2084N0400X , with the licence number:  36504 , 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: 0006601 . This is a "NEIGHBORHOOD HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 454629 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11015 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9723889 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SO 07787 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 706630 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 104517 . This is a "BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4517-7 . This is a "RI BCBS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0501000 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NO 00985 . This is a "EDS RI MEDICAID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000024259 . This is a "BOSTON MEDICAL HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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