1871785790 NPI number — DR. JOHN E MATHEWS PSYD

Table of content: DR. JOHN E MATHEWS PSYD (NPI 1871785790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871785790 NPI number — DR. JOHN E MATHEWS PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWS
Provider First Name:
JOHN
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1871785790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01983-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-887-6173
Provider Business Mailing Address Fax Number:
978-887-6173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01983-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-887-6173
Provider Business Practice Location Address Fax Number:
978-887-6173
Provider Enumeration Date:
08/14/2007

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: 103G00000X , with the licence number:  4095 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 4095 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 4095 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TH0100X , with the licence number: 4095 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X , with the licence number: 4095 , 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: MA-W50626 . This is a "MEDICARE B" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0518441 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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