1518012509 NPI number — DR. TRACY REBECCA ZINNER M.D.

Table of content: COLLEEN M MORAN-BANO MD (NPI 1083684245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518012509 NPI number — DR. TRACY REBECCA ZINNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZINNER
Provider First Name:
TRACY
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITENER
Provider Other First Name:
TRACY
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D,
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518012509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BROOKLINE PL STE 620
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-7296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-735-8800
Provider Business Mailing Address Fax Number:
617-278-9358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BROOKLINE PL
Provider Second Line Business Practice Location Address:
SUITE, 521
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02445-7224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-735-8800
Provider Business Practice Location Address Fax Number:
617-278-9358
Provider Enumeration Date:
01/23/2007

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: 207V00000X , with the licence number:  212991 , 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: 0026961 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0179591 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 131624 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 405183 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J24926 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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