1831187723 NPI number — LEA A. GOTTFREDSEN

Table of content: LEA A. GOTTFREDSEN (NPI 1831187723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831187723 NPI number — LEA A. GOTTFREDSEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOTTFREDSEN
Provider First Name:
LEA
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1831187723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HEALTHCARE DR
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03867-4499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-330-3404
Provider Business Mailing Address Fax Number:
603-332-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 HEALTHCARE DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03867-4499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-330-3404
Provider Business Practice Location Address Fax Number:
603-332-8175
Provider Enumeration Date:
10/13/2005

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: 207R00000X , with the licence number:  12456 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: U41350 . This is a "ANTHEM RAN REFERRAL #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2129565 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 101115806 . This is a "W/C DEPT OF LABOR PIN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 04YP08097NH01 . This is a "ANTHEM ACES #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30223406 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 714733 . This is a "HPHC" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 150489 . This is a "TUFTS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3788702 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com