1366731291 NPI number — GREATER BOSTON GASTROENTEROLGY, PC

Table of content: (NPI 1366731291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366731291 NPI number — GREATER BOSTON GASTROENTEROLGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER BOSTON GASTROENTEROLGY, 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:
1366731291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 FRANKLIN ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-6264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-620-9200
Provider Business Mailing Address Fax Number:
508-620-6483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-6264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-620-9200
Provider Business Practice Location Address Fax Number:
508-620-6483
Provider Enumeration Date:
03/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
508-620-9200

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 637393 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: DB5286 . This is a "RR MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M21436 . This is a "MEDICARE / PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9738487 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92401 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17578 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3663248 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com