1356334544 NPI number — ROBERT N. ULSETH, MD, PC

Table of content: (NPI 1356334544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356334544 NPI number — ROBERT N. ULSETH, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT N. ULSETH, MD, 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:
1356334544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2864
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUXBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02331-2864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-934-0135
Provider Business Mailing Address Fax Number:
781-934-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 TREMONT ST
Provider Second Line Business Practice Location Address:
BLDG 9, SUITE 17
Provider Business Practice Location Address City Name:
DUXBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02332-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-934-0135
Provider Business Practice Location Address Fax Number:
781-934-0425
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ULSETH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
NORMAN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
781-934-0135

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  49764 , 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: 0004519894 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M13736 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 080006250 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7045 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 723013 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9733515 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0508611 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6789727 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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