1588291769 NPI number — MAGGIE MINYAN MOUZOURAKIS MD

Table of content: MAGGIE MINYAN MOUZOURAKIS MD (NPI 1588291769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588291769 NPI number — MAGGIE MINYAN MOUZOURAKIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOUZOURAKIS
Provider First Name:
MAGGIE
Provider Middle Name:
MINYAN
Provider Name Prefix Text:
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:
WANG
Provider Other First Name:
MAGGIE
Provider Other Middle Name:
MINYAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588291769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
DHMC DEPARTMENT OF OTOLARYNGOLOGY
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-650-6033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
DHMC DEPARTMENT OF OTOLARYNGOLOGY
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-650-6033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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