1609934140 NPI number — MRS. CHERYL L CURTIS P.A. -C

Table of content: MRS. CHERYL L CURTIS P.A. -C (NPI 1609934140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609934140 NPI number — MRS. CHERYL L CURTIS P.A. -C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURTIS
Provider First Name:
CHERYL
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A. -C
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:
1609934140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 FRANCIS ST STE 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215-5501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-632-8383
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 BROOKLINE AVE # SHAPIRO7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-667-8800
Provider Business Practice Location Address Fax Number:
949-650-1274
Provider Enumeration Date:
12/05/2006

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: 363AS0400X , with the licence number:  PA18172 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 330204983 0048 . This is a "CIGNA GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PA17172 . This is a "CA LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 330204983 . This is a "TAX ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 330204983 0039 . This is a "CIGNA GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: YYY49979Y . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000000135 . This is a "GNP GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 019023 . This is a "GNP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750339479 . This is a "NPI GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR002729 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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