1497966550 NPI number — PATRICIA DELL-ROSS, INC.

Table of content: (NPI 1497966550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497966550 NPI number — PATRICIA DELL-ROSS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA DELL-ROSS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1497966550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 PLEASANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-618-7994
Provider Business Mailing Address Fax Number:
978-462-7333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURYPORT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01950-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-618-7994
Provider Business Practice Location Address Fax Number:
978-462-7333
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELL-ROSS
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-618-7994

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0104653 , 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: 052384020 . This is a "MAGELLAN ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004112 . This is a "VALUE OPTIONS INDIV ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1404200YOMA01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4212987 . This is a "AETNA ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P10260 . This is a "BCBS MA GROUP ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P50031 . This is a "BCBS INDIV ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 684200 . This is a "BEACON HS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1014950 . This is a "FALLON ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A021518 . This is a "VALUE OPTIONS ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1039062 . This is a "CIGNA ID NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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