1568558930 NPI number — MARY E SCANNELL MD PC

Table of content: (NPI 1568558930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568558930 NPI number — MARY E SCANNELL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY E SCANNELL MD PC
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:
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:
1568558930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 WEST BOYLSTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01606-2726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-853-6662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 WEST BOYLSTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01606-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-853-6662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCANNELL
Authorized Official First Name:
MARY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-853-6662

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0017847 . This is a "NHP GROUP PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CK8091 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8510 . This is a "FALLON VENDOR ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M15675 . This is a "BC/BS GROUP PROVIDER ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 607331 . This is a "TUFTS GROUP PAYEE ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9769498 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com