1831205012 NPI number — MRS. SUZANNE E IOVANNI R.D., L.D.N.

Table of content: MRS. SUZANNE E IOVANNI R.D., L.D.N. (NPI 1831205012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831205012 NPI number — MRS. SUZANNE E IOVANNI R.D., L.D.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IOVANNI
Provider First Name:
SUZANNE
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., L.D.N.
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:
1831205012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 GILCHREST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUNENBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01462-1121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-420-6542
Provider Business Mailing Address Fax Number:
978-582-7171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 GILCHREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUNENBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01462-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-420-6542
Provider Business Practice Location Address Fax Number:
978-582-7171
Provider Enumeration Date:
08/21/2006

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: 133V00000X , with the licence number:  391 , 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: 467929 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA22441 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: LD0162 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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