1316909005 NPI number — JEFFREY STEVEN DOVER MD

Table of content: JEFFREY STEVEN DOVER MD (NPI 1316909005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316909005 NPI number — JEFFREY STEVEN DOVER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOVER
Provider First Name:
JEFFREY
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1316909005
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:
1244 BOYLSTON ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-731-1600
Provider Business Mailing Address Fax Number:
617-731-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1244 BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CHESTNUT HILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02467-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-731-1600
Provider Business Practice Location Address Fax Number:
617-731-1601
Provider Enumeration Date:
04/06/2006

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: 207N00000X , with the licence number:  55225 , 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: 2645584 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: V03240 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0304452 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 724271 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401004BI . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4536141-002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0020035 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29005 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000157 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".




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