1508089871 NPI number — CLAUDIA JANET CARTAGENA PA-C

Table of content: CLAUDIA JANET CARTAGENA PA-C (NPI 1508089871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508089871 NPI number — CLAUDIA JANET CARTAGENA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTAGENA
Provider First Name:
CLAUDIA
Provider Middle Name:
JANET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1508089871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
588 PAWTUCKET AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-6057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-722-2400
Provider Business Mailing Address Fax Number:
401-728-3920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
588 PAWTUCKET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-6057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-722-2400
Provider Business Practice Location Address Fax Number:
401-728-3920
Provider Enumeration Date:
04/11/2007

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: 363A00000X , with the licence number:  PA00400 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA00400 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1508089 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32716-3 . This is a "BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 979005394 . This is a "RI MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 939025129 . This is a "RI MEDICARE GROUP NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 01/15/2008 . This is a "NHPRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1508089871 . This is a "NPI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 414115 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 04-15-2009 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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