1609807007 NPI number — THOMAS P LEBOSQUET III MD

Table of content: THOMAS P LEBOSQUET III MD (NPI 1609807007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609807007 NPI number — THOMAS P LEBOSQUET III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEBOSQUET
Provider First Name:
THOMAS
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1609807007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 BORTHWICK AVE
Provider Second Line Business Mailing Address:
EMERGENCY DEPT
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-7128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-433-4012
Provider Business Mailing Address Fax Number:
603-433-5184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BORTHWICK AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-433-4012
Provider Business Practice Location Address Fax Number:
603-433-5184
Provider Enumeration Date:
07/05/2006

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: 207PE0004X , with the licence number:  13217 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 2012-02232 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 432341899 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00381605 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30206219 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01Y011074NH01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2124076 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com