1346641503 NPI number — FRANK TWAROG MD PHD AND CURTIS MOODY MD LLP

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 1346641503 NPI number — FRANK TWAROG MD PHD AND CURTIS MOODY MD LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK TWAROG MD PHD AND CURTIS MOODY MD LLP
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:
1346641503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BROOKLINE PL
Provider Second Line Business Mailing Address:
STE 424
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-7224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-735-8750
Provider Business Mailing Address Fax Number:
617-735-8752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BROOKLINE PL
Provider Second Line Business Practice Location Address:
STE 424
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02445-7224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-735-8750
Provider Business Practice Location Address Fax Number:
617-735-8752
Provider Enumeration Date:
09/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
JACALYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
978-369-3567

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  57637 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: 34521 , 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: M20418 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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