1609857747 NPI number — ROBERT G SOUCY JR. DO

Table of content: ROBERT G SOUCY JR. DO (NPI 1609857747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609857747 NPI number — ROBERT G SOUCY JR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUCY
Provider First Name:
ROBERT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
DO
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:
1609857747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 OAKES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLEBROOK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03576-6117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-237-5008
Provider Business Mailing Address Fax Number:
281-393-4203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 OAKES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLEBROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03576-6117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-237-5008
Provider Business Practice Location Address Fax Number:
281-393-4203
Provider Enumeration Date:
11/07/2005

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: 207Q00000X , with the licence number:  8182 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000101 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0405411Y0NH02 . This is a "ANTHEM NH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3094399 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8080 . This is a "VTBLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21211 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 341982 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 80159325 . This is a "RR MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30002940 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: A78574 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0405411Y0NH03 . This is a "ANTHEM NH" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com