1437109261 NPI number — VLADIMIR BARIN

Table of content: VLADIMIR BARIN (NPI 1437109261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437109261 NPI number — VLADIMIR BARIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARIN
Provider First Name:
VLADIMIR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1437109261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 BAKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ROXBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02132-4238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-782-5100
Provider Business Mailing Address Fax Number:
617-782-5122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556 CAMBRIDGE ST
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:
02134-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-782-5100
Provider Business Practice Location Address Fax Number:
617-782-5122
Provider Enumeration Date:
05/11/2006

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: 111N00000X , with the licence number:  2641 , 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: 3757360 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110030600/A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7897681 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA112184 . This is a "HARVARD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y37002 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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