1841385317 NPI number — AGUSTIN M FLORIAN MD

Table of content: AGUSTIN M FLORIAN MD (NPI 1841385317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841385317 NPI number — AGUSTIN M FLORIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLORIAN
Provider First Name:
AGUSTIN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1841385317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MORSE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-4679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-352-3153
Provider Business Mailing Address Fax Number:
781-352-3154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MORSE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062-4679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-352-3153
Provider Business Practice Location Address Fax Number:
781-352-3154
Provider Enumeration Date:
10/03/2006

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: 208G00000X , with the licence number:  36437 , 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: 18-02000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 441333831 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700405 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0013607 . This is a "NEIGHBERHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0110078 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26001 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0024458 . This is a "AETNA HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: C18088 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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