1376014506 NPI number — MARYCILENE RAFTERY RAMIREZ MSC

Table of content: MARYCILENE RAFTERY RAMIREZ MSC (NPI 1376014506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376014506 NPI number — MARYCILENE RAFTERY RAMIREZ MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAFTERY RAMIREZ
Provider First Name:
MARYCILENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAFTERY RAMIREZ
Provider Other First Name:
MARYCILENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
101Y00000X
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376014506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 CANAL PARK PH 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02141-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-800-7005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 FORDHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02134-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-620-5894
Provider Business Practice Location Address Fax Number:
617-782-6444
Provider Enumeration Date:
12/16/2018

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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