1427262799 NPI number — LAURENCE J. SLOSS, M.D.

Table of content: (NPI 1427262799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427262799 NPI number — LAURENCE J. SLOSS, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURENCE J. SLOSS, M.D.
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:
1427262799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 BEACON ST
Provider Second Line Business Mailing Address:
STE. 703W
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-5587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-738-6878
Provider Business Mailing Address Fax Number:
617-730-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 BEACON ST
Provider Second Line Business Practice Location Address:
STE. 703W
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02446-5587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-738-6878
Provider Business Practice Location Address Fax Number:
617-730-9915
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SLOSS
Authorized Official First Name:
LAURENCE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
617-738-6878

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  36075 , 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: 25-04965 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: M18866 . This is a "BCBS GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2029367 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 708600 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952376519 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: A66794BWHT . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M08724 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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