1689896136 NPI number — HEIKE ROLLE-DAYA, MD

Table of content: (NPI 1689896136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689896136 NPI number — HEIKE ROLLE-DAYA, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEIKE ROLLE-DAYA, 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:
1689896136
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:
3 WOODLAND ROAD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
STONEHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02180-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-662-2100
Provider Business Mailing Address Fax Number:
781-662-7807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 WOODLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
STONEHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02180-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-662-2100
Provider Business Practice Location Address Fax Number:
781-662-7807
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENOS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
781-662-2100

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2027321 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2035472 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1346231883 . This is a "NPI - HEIKE ROLLE-DAYA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1780675231 . This is a "NPI - KANTA NAGPAUL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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