1508989989 NPI number — DR. ADAM PAVLE CUGALJ D.O.

Table of content: DR. ADAM PAVLE CUGALJ D.O. (NPI 1508989989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508989989 NPI number — DR. ADAM PAVLE CUGALJ D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUGALJ
Provider First Name:
ADAM
Provider Middle Name:
PAVLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1508989989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 HAWTHORNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-6983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-472-8888
Provider Business Mailing Address Fax Number:
603-472-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 HAWTHORNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03110-6983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-472-8888
Provider Business Practice Location Address Fax Number:
603-472-9090
Provider Enumeration Date:
04/09/2007

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: 208100000X , with the licence number:  14010 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30226724 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9065161 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02899627 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA121468 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1015184 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613430500 . This is a "US DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3004741 . This is a "MVP HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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