1528049772 NPI number — DR. REGINA M MOSTONE DPM

Table of content: DR. REGINA M MOSTONE DPM (NPI 1528049772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528049772 NPI number — DR. REGINA M MOSTONE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSTONE
Provider First Name:
REGINA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1528049772
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BLUFFS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02557-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-684-4500
Provider Business Mailing Address Fax Number:
508-684-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BLUFFS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02557-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-684-4500
Provider Business Practice Location Address Fax Number:
508-684-4502
Provider Enumeration Date:
11/07/2005

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: 213ES0131X , with the licence number:  1903 , 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: 001903 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 22730 . This is a "FALLON HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 27-00020 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B20354101 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y70898 . This is a "BLUE SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S002873 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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