1780652263 NPI number — KATHLEEN A DIETZ-LOVETT NP

Table of content: KATHLEEN A DIETZ-LOVETT NP (NPI 1780652263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780652263 NPI number — KATHLEEN A DIETZ-LOVETT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIETZ-LOVETT
Provider First Name:
KATHLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIETZ
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780652263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 PARK STREET
Provider Second Line Business Mailing Address:
CAPE COD HOSPITAL DAVENPORT MUGAR CANCER CENTER
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-862-7575
Provider Business Mailing Address Fax Number:
508-862-7362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 PARK STREET
Provider Second Line Business Practice Location Address:
CAPE COD HOSPITAL DAVENPORT MUGAR CANCER CENTER
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-862-7575
Provider Business Practice Location Address Fax Number:
508-862-7362
Provider Enumeration Date:
03/09/2006

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: 363LA2200X , with the licence number:  207866 , 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: NP2696 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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