1407042856 NPI number — MARTIN J. NAUGHTON, M.D. LTD

Table of content: (NPI 1407042856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407042856 NPI number — MARTIN J. NAUGHTON, M.D. LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN J. NAUGHTON, M.D. LTD
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:
6
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:
1407042856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3645 WARREN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89509-5241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-825-3838
Provider Business Mailing Address Fax Number:
775-825-3890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3645 WARREN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-825-3838
Provider Business Practice Location Address Fax Number:
775-825-3890
Provider Enumeration Date:
09/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAUGHTON
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
775-324-4477

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  4265 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002016982 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".