1447268222 NPI number — MARK R VANELLI M.D.

Table of content: MARK R VANELLI M.D. (NPI 1447268222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447268222 NPI number — MARK R VANELLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANELLI
Provider First Name:
MARK
Provider Middle Name:
R
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:
1447268222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 260
Provider Second Line Business Mailing Address:
MOAK ASSOCIATES
Provider Business Mailing Address City Name:
WESTBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01581-0260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-898-8650
Provider Business Mailing Address Fax Number:
508-870-9793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 LONGMEADOW RD
Provider Second Line Business Practice Location Address:
MOAK ASSOCIATES
Provider Business Practice Location Address City Name:
WESTBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01581-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-898-8650
Provider Business Practice Location Address Fax Number:
508-870-9793
Provider Enumeration Date:
08/04/2006

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: 2084P0800X , with the licence number:  60076 , 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: 15-00999 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J09205 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3056244 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 776748 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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