1760627673 NPI number — PAULA MCQUAID P.T., M.T., C.S.T.

Table of content: PAULA MCQUAID P.T., M.T., C.S.T. (NPI 1760627673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760627673 NPI number — PAULA MCQUAID P.T., M.T., C.S.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCQUAID
Provider First Name:
PAULA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., M.T., C.S.T.
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:
1760627673
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 GREGLEN AVE
Provider Second Line Business Mailing Address:
BOX #108
Provider Business Mailing Address City Name:
NANTUCKET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02554-2830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-228-7577
Provider Business Mailing Address Fax Number:
508-228-7571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 OLD SOUTH RD
Provider Second Line Business Practice Location Address:
BUILDING C #9
Provider Business Practice Location Address City Name:
NANTUCKET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02554-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-228-7577
Provider Business Practice Location Address Fax Number:
508-228-7571
Provider Enumeration Date:
12/05/2008

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: 225100000X , with the licence number:  11039 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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