1629271168 NPI number — SUSAN M. YEOMANS, M.D., P.C.

Table of content: (NPI 1629271168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629271168 NPI number — SUSAN M. YEOMANS, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN M. YEOMANS, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1629271168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 BOSTON POST RD W STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01752-1878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-481-0815
Provider Business Mailing Address Fax Number:
508-481-0820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 BOSTON POST RD W STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752-1878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-481-0815
Provider Business Practice Location Address Fax Number:
508-481-0820
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YEOMANS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
508-481-0815

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  59025 , 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: 9750070 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9900243 . This is a "FALLON COMM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA27711 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 35481118 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 637385 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AS23327700001 . This is a "CIGNA CT GENERAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18929 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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