1548321458 NPI number — MICHAEL LAKHER OD

Table of content: MICHAEL LAKHER OD (NPI 1548321458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548321458 NPI number — MICHAEL LAKHER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKHER
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAKHER
Provider Other First Name:
MIKHAIL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548321458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 MANSFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-431-7762
Provider Business Mailing Address Fax Number:
617-232-9201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 HARVARD ST S 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-232-9200
Provider Business Practice Location Address Fax Number:
617-232-9201
Provider Enumeration Date:
12/13/2006

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: 152W00000X , with the licence number:  3437 , 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: B20929001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5856168 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: LAW15749 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 762361 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: U30748 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA3437 . This is a "EYE MED COLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2200040 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0354414 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12119 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".




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