1811072986 NPI number — MICHELE A MATHIEU M.D.

Table of content: MICHELE A MATHIEU M.D. (NPI 1811072986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811072986 NPI number — MICHELE A MATHIEU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHIEU
Provider First Name:
MICHELE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811072986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 MEEHAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02864-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-658-2525
Provider Business Mailing Address Fax Number:
401-658-3031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 MEEHAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02864-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-658-2525
Provider Business Practice Location Address Fax Number:
401-658-3031
Provider Enumeration Date:
10/26/2006

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: 208000000X , with the licence number:  MD11209 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 24223 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 465505 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 411014 . This is a "BC/BS BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1046647 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 12-03693 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: PY01057 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9024223 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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