1497880207 NPI number — DR. ERIC ENRICO GUARDINO M.D.

Table of content: DR. ERIC ENRICO GUARDINO M.D. (NPI 1497880207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497880207 NPI number — DR. ERIC ENRICO GUARDINO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUARDINO
Provider First Name:
ERIC
Provider Middle Name:
ENRICO
Provider Name Prefix Text:
DR.
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:
1497880207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 CLARKE ST
Provider Second Line Business Mailing Address:
UNIT B4
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421-4988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-863-6053
Provider Business Mailing Address Fax Number:
781-862-7565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 CLARKE ST
Provider Second Line Business Practice Location Address:
UNIT B4
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02421-4988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-863-6053
Provider Business Practice Location Address Fax Number:
781-862-7565
Provider Enumeration Date:
02/22/2007

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:  57734 , 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: 3034895 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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