1578649745 NPI number — DR. DIANE JOAN SCHWEITZER MD

Table of content: DR. DIANE JOAN SCHWEITZER MD (NPI 1578649745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578649745 NPI number — DR. DIANE JOAN SCHWEITZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWEITZER
Provider First Name:
DIANE
Provider Middle Name:
JOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578649745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 JEFFERSON ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-277-9084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
464 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-449-5170
Provider Business Practice Location Address Fax Number:
781-449-5171
Provider Enumeration Date:
10/31/2006

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: 207R00000X , with the licence number:  34757 , 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: 3089584 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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