1801957931 NPI number — LINDA GAYLE SHEPARD SALZER MA

Table of content: LINDA GAYLE SHEPARD SALZER MA (NPI 1801957931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801957931 NPI number — LINDA GAYLE SHEPARD SALZER MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPARD SALZER
Provider First Name:
LINDA
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEPARD
Provider Other First Name:
LINDA
Provider Other Middle Name:
GAYLE
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:
1801957931
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:
1040 WALTHAM STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421-8033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-862-3600
Provider Business Mailing Address Fax Number:
781-863-5903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 WALTHAM STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02421-8033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-862-3600
Provider Business Practice Location Address Fax Number:
781-863-5903
Provider Enumeration Date:
12/13/2006

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: 101YM0800X , 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: 703136 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 99618201 . This is a "NETWORK HLTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1303287 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M18633 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1004745 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1303287 . This is a "MBHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NP01332 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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