1437157765 NPI number — JOHN B CONSTANTINE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437157765 NPI number — JOHN B CONSTANTINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONSTANTINE
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1437157765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 VILLAGE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-256-5600
Provider Business Mailing Address Fax Number:
978-703-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 VILLAGE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-256-5600
Provider Business Practice Location Address Fax Number:
978-703-0250
Provider Enumeration Date:
07/11/2005

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: 174400000X , with the licence number:  71751 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 71751 , 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: 981909 . This is a "NET WORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 158296 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 21480 . This is a "HEALTH SOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7494 . This is a "DAVIS VISION" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004859 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 15288 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 32774 . This is a "JOHN HANCOCK/CHILDERN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P451314 . This is a "OXFORD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 180007 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0800093 . This is a "EVER CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 21879 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B26214 . This is a "BC/BS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "20516" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S000303 . This is a "CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2024535 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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