1457458614 NPI number — MARA LINSCOTT MD

Table of content: MARA LINSCOTT MD (NPI 1457458614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457458614 NPI number — MARA LINSCOTT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINSCOTT
Provider First Name:
MARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1457458614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 TARKILN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02364-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-585-2200
Provider Business Mailing Address Fax Number:
781-585-1784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 TARKILN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02364-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-585-2200
Provider Business Practice Location Address Fax Number:
781-585-1784
Provider Enumeration Date:
09/20/2006

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: 207R00000X , with the licence number:  242263 , 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: 110084539A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042297845 . This is a "HCVM/FIRST HEALTH/COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 495210 . This is a "TUFTS MEDICARE PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "GIC/UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "PHCS/MULTI-PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1457458614 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: J46719 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7984860 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042297845 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 495210 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1457458614 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6395310 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA169440 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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