1326309667 NPI number — BRENT C THERRIEN

Table of content: BRENT C THERRIEN (NPI 1326309667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326309667 NPI number — BRENT C THERRIEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THERRIEN
Provider First Name:
BRENT
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1326309667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 HAVERHILL RD
Provider Second Line Business Mailing Address:
STE 524
Provider Business Mailing Address City Name:
AMESBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01913-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-388-7272
Provider Business Mailing Address Fax Number:
978-388-7373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 LAFAYETTE RD
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
SEABROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03874-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-474-2259
Provider Business Practice Location Address Fax Number:
603-474-2253
Provider Enumeration Date:
06/04/2012

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: 225100000X , with the licence number:  3713 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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