1811092000 NPI number — RIMAWI PEDIATRICS PC

Table of content: (NPI 1811092000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811092000 NPI number — RIMAWI PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIMAWI PEDIATRICS 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:
Provider Other Organization Name Type Code:
6
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:
1811092000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-489-5546
Provider Business Mailing Address Fax Number:
781-489-5769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 WALNUT ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-489-5546
Provider Business Practice Location Address Fax Number:
781-489-5769
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIMAWI
Authorized Official First Name:
LAMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-232-3132

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  160607 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0006X , with the licence number: 160021 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3198341 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0109070 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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