1518250216 NPI number — PAVIA ASSOCIATES INC

Table of content: (NPI 1518250216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518250216 NPI number — PAVIA ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAVIA ASSOCIATES 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:
6
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:
1518250216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03802-8216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-569-2790
Provider Business Mailing Address Fax Number:
603-569-1084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BORTHWICK AVE
Provider Second Line Business Practice Location Address:
PORTSMOUTH REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-433-6994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SNOW
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-569-2790

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  6401 , 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: 0102572Y0NH01 . This is a "ANTHEM BC/BS NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 82080149 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".