1740245505 NPI number — STEPHANIE G MACAUSLAND M.D

Table of content: STEPHANIE G MACAUSLAND M.D (NPI 1740245505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740245505 NPI number — STEPHANIE G MACAUSLAND M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACAUSLAND
Provider First Name:
STEPHANIE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1740245505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PROSPECT ST
Provider Second Line Business Mailing Address:
DEPARTMENT OF RADIATION ONCOLOGY
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01757-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-488-3800
Provider Business Mailing Address Fax Number:
508-488-3800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 PROSPECT ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIATION ONCOLOGY
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01757-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-488-3800
Provider Business Practice Location Address Fax Number:
508-488-3800
Provider Enumeration Date:
04/17/2006

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: 2085R0001X , with the licence number:  MD11843 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: 212902 , 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: 7057906 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3600729 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4804-8 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AA38707 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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