1770656548 NPI number — CATHLEEN LONDON MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770656548 NPI number — CATHLEEN LONDON MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHLEEN LONDON MD PC
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:
ALLIANCE HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1770656548
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:
209 HARVARD ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-5071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-232-0616
Provider Business Mailing Address Fax Number:
617-232-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 HARVARD ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BROOKLINE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02446-5071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-232-0616
Provider Business Practice Location Address Fax Number:
617-232-0604
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LONDON
Authorized Official First Name:
CATHLEEN
Authorized Official Middle Name:
GREENBERG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-232-0616

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  158107 , 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: M17740 . This is a "BCBS GROUP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9707760 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J19911 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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