1487735486 NPI number — DR. PAUL KENT LOUSCHER PHD

Table of content: DR. PAUL KENT LOUSCHER PHD (NPI 1487735486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487735486 NPI number — DR. PAUL KENT LOUSCHER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOUSCHER
Provider First Name:
PAUL
Provider Middle Name:
KENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1487735486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 LINDEN ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-7359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-232-0662
Provider Business Mailing Address Fax Number:
617-232-0662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
169 LIBBEY INDUSTRIAL PKWY
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02189-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-682-1060
Provider Business Practice Location Address Fax Number:
781-682-1061
Provider Enumeration Date:
10/17/2006

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: 103TC1900X , with the licence number:  8273 , 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: 136105000 . This is a "MAGELLAN MIS#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W06348 . This is a "BC/BS HMO BLUE, AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".