1457415168 NPI number — MS. LYNDA M MARTIN MS F AAA

Table of content: MS. LYNDA M MARTIN MS F AAA (NPI 1457415168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457415168 NPI number — MS. LYNDA M MARTIN MS F AAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
LYNDA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS F AAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
LYNDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS-FAAA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457415168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 SHREWSBURY ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01604-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-755-1391
Provider Business Mailing Address Fax Number:
508-363-4019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 LINCOLN ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-755-1391
Provider Business Practice Location Address Fax Number:
508-363-4019
Provider Enumeration Date:
12/20/2006

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: 231H00000X , with the licence number:  135 , 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: 043258935 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 680034 . This is a "SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 680034 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS8957304000 . This is a "CIGNA OUT OF NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5102669 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 043258935 . This is a "GIC GROUP INS COMMISSION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043258935 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043258935 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26550 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 650422 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: WORC22004 . This is a "HEAR PO" identifier . This identifiers is of the category "OTHER".




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