1538173380 NPI number — LAURA J ALTAVILLA DC

Table of content: LAURA J ALTAVILLA DC (NPI 1538173380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538173380 NPI number — LAURA J ALTAVILLA DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALTAVILLA
Provider First Name:
LAURA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1538173380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 WHITNEY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDNER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-632-5885
Provider Business Mailing Address Fax Number:
978-630-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 WHITNEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDNER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-632-5885
Provider Business Practice Location Address Fax Number:
978-630-3774
Provider Enumeration Date:
07/28/2006

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: 111N00000X , with the licence number:  1336 , 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: 2045784 . This is a "FIRST HEALTH CNN HCVM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1609149 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609149 . This is a "MASSHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351050 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043116527 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15021 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 898687 . This is a "FOCUS BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 986271 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y35953 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203139600 . This is a "ACS DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30700 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OO13407 . This is a "NEIGHBORHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350053673 . This is a "RR MEDICARE PALMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80705 . This is a "ONE HEALTH GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: RRCAT810191834 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y35953 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 210035 . This is a "ACN ASHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4481980 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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