1326076795 NPI number — PRIOR LEWIS PARKER MD

Table of content: PRIOR LEWIS PARKER MD (NPI 1326076795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326076795 NPI number — PRIOR LEWIS PARKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
PRIOR
Provider Middle Name:
LEWIS
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:
1326076795
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:
17 WELLS ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WESTERLY
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02891-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-596-0339
Provider Business Mailing Address Fax Number:
401-596-3437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SANDY HOLLOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYSTIC
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06355-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-536-4916
Provider Business Practice Location Address Fax Number:
860-536-3247
Provider Enumeration Date:
06/28/2006

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: 207W00000X , with the licence number:  031338 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NLS023 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA33963 . This is a "HARVARD PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180000515 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001313387 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004298 . This is a "BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 180000515 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000002011 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000002064 . This is a "BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 010031338CT01 . This is a "BLUESHIELD OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030080 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 966013 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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