1699850214 NPI number — DR. RICHARD YILIN ZHANG OD, PH.D

Table of content: DR. RICHARD YILIN ZHANG OD, PH.D (NPI 1699850214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699850214 NPI number — DR. RICHARD YILIN ZHANG OD, PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZHANG
Provider First Name:
RICHARD
Provider Middle Name:
YILIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD, PH.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZHANG
Provider Other First Name:
YILIN
Provider Other Middle Name:
R.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD PH.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699850214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 CLARKE ST
Provider Second Line Business Mailing Address:
B2
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-676-2020
Provider Business Mailing Address Fax Number:
781-676-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 CLARKE ST
Provider Second Line Business Practice Location Address:
B2
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-676-2020
Provider Business Practice Location Address Fax Number:
781-676-2021
Provider Enumeration Date:
10/25/2006

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: 152W00000X , with the licence number:  0673 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 4116 , 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: 22-04131 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 806550 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 971342 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA2096 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0024967 . This is a "NEIGHBORHOOD HELATH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W16194 . This is a "MCMS (MA)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2676542 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 31167 . This is a "AVESIS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: ZH1327315 . This is a "CLARITY VISION" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 09Y004242NH01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0317420 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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