1750451795 NPI number — DRAGANA DORAN MD

Table of content: DRAGANA DORAN MD (NPI 1750451795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750451795 NPI number — DRAGANA DORAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORAN
Provider First Name:
DRAGANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750451795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 FAIRFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-492-2420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 SUMMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-469-1480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

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: 207R00000X , with the licence number:  76364 , 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: 1750451795 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204685284 . This is a "JHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1750451795 . This is a "NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: J13711 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9708086 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00369071 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2134039 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30206739 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA89167 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".




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