1477528628 NPI number — WALTER JAMES HEALEY M.D.

Table of content: WALTER JAMES HEALEY M.D. (NPI 1477528628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477528628 NPI number — WALTER JAMES HEALEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEALEY
Provider First Name:
WALTER
Provider Middle Name:
JAMES
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:
1477528628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 RACE POINT ROAD
Provider Second Line Business Mailing Address:
UNIT B, GOSNOLD-THORNE COUNSELING
Provider Business Mailing Address City Name:
PROVINCETOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-487-2449
Provider Business Mailing Address Fax Number:
508-487-1921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CONWELL ST
Provider Second Line Business Practice Location Address:
GOSNOLD THORNE COUNSELING
Provider Business Practice Location Address City Name:
PROVINCETOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02657-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-487-2449
Provider Business Practice Location Address Fax Number:
508-487-1921
Provider Enumeration Date:
02/21/2006

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:  150216 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X , with the licence number: 150216 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5293582 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 150216 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 15512200 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3165540 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J18180 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 260037303 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4383-01 . This is a "PACIFICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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