1649256504 NPI number — ROBERT H. ACKERMAN, MD

Table of content: (NPI 1649256504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649256504 NPI number — ROBERT H. ACKERMAN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT H. ACKERMAN, MD
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:
6
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:
1649256504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 STILES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-2846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-893-9784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FRUIT ST
Provider Second Line Business Practice Location Address:
CLN 340
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-547-1620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ACKERMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
800-927-0002

Provider Taxonomy Codes

  • Taxonomy code: 284300000X , 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: 2085135 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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