1407996481 NPI number — DR. KAREN ELIZABETH CALDWELL MD-PHD

Table of content: DR. KAREN ELIZABETH CALDWELL MD-PHD (NPI 1407996481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407996481 NPI number — DR. KAREN ELIZABETH CALDWELL MD-PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALDWELL
Provider First Name:
KAREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD-PHD
Provider Gender Code:
F

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:
1407996481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
694 WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01905-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-595-7348
Provider Business Mailing Address Fax Number:
781-598-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
269 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01901-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-596-2502
Provider Business Practice Location Address Fax Number:
781-596-3966
Provider Enumeration Date:
02/07/2007

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: 207RR0500X , with the licence number:  231625 , 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: 2146452 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257894800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".