1467487421 NPI number — CARRIE M DAVIES M.D.

Table of content: CARRIE M DAVIES M.D. (NPI 1467487421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467487421 NPI number — CARRIE M DAVIES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIES
Provider First Name:
CARRIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1467487421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MAIN STREET PEDIATRICS
Provider Second Line Business Mailing Address:
77 WEST MAIN STREET
Provider Business Mailing Address City Name:
HOPKINTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-435-5506
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MAIN STREET PEDIATRICS
Provider Second Line Business Practice Location Address:
77 WEST MAIN STREET
Provider Business Practice Location Address City Name:
HOPKINTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-435-5506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

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: 208000000X , with the licence number:  156562 , 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: 156562 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 202206 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0103870 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2121339 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 12-01600 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J22134 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5842725 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B10363601 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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