1629062781 NPI number — MICHELE T CHABOT MD

Table of content: MICHELE T CHABOT MD (NPI 1629062781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629062781 NPI number — MICHELE T CHABOT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHABOT
Provider First Name:
MICHELE
Provider Middle Name:
T
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:
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:
1629062781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HIGHLAND ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02186-3881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-696-1460
Provider Business Mailing Address Fax Number:
617-296-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HIGHLAND ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02186-3881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-696-1460
Provider Business Practice Location Address Fax Number:
617-296-5801
Provider Enumeration Date:
09/06/2005

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: 207R00000X , with the licence number:  78819 , 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: 043243146 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00039909 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043243146 . This is a "HC VM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21232424344 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3157475 . This is a "AETNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16434 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0403312 . This is a "UNITED HEALTHCARE OF NE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043243146 . This is a "MEDICARE PREFERRED TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 078819 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6261611009 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M15986 . This is a "BLUE CROSS INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16434 . This is a "BLUE CROSS INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043243146 . This is a "GREAT WEST HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J16434 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3148823 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66029 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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