1336266832 NPI number — NEVILLE MEDICAL ASSOCIATES INC. PC

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 1336266832 NPI number — NEVILLE MEDICAL ASSOCIATES INC. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVILLE MEDICAL ASSOCIATES INC. PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336266832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 ALGONQUIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01810-5527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-475-4197
Provider Business Mailing Address Fax Number:
978-682-8343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01840-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-682-8343
Provider Business Practice Location Address Fax Number:
978-682-8343
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAVARATNAM
Authorized Official First Name:
RAJU
Authorized Official Middle Name:
NEVILLE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-475-4197

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  74287 , 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: 9768041 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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