1619966926 NPI number — LARRY A LITSCHER M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619966926 NPI number — LARRY A LITSCHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITSCHER
Provider First Name:
LARRY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1619966926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
382 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
E LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-525-8601
Provider Business Mailing Address Fax Number:
413-525-8604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
382 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
E LONGMEADOW
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01028-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-525-8601
Provider Business Practice Location Address Fax Number:
413-525-8604
Provider Enumeration Date:
10/19/2005

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: 207W00000X , with the licence number:  54086 , 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: 0002295 . This is a "GROUP PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110047857A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053503912 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1619966926 . This is a "NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S400180318 . This is a "ACTIVE PROVIDER TRANSACTION ACCESS NUMBER" identifier . This identifiers is of the category "OTHER".




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