1891054003 NPI number — MICHEL LIRETTE MD LLC

Table of content: (NPI 1891054003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891054003 NPI number — MICHEL LIRETTE MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHEL LIRETTE MD LLC
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:
1891054003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 TURNPIKE ST
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
NORTH ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-681-4505
Provider Business Mailing Address Fax Number:
978-681-4507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 TURNPIKE ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
NORTH ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01845-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-681-4505
Provider Business Practice Location Address Fax Number:
978-681-4507
Provider Enumeration Date:
05/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CROTEAU
Authorized Official First Name:
GINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
978-681-4505

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: 76941 , 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: J13903 . This is a "BLUESHIELD OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17018 . This is a "BLUESHIELD OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3110541 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13002 . This is a "HARVARDPILGRIM HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 730461 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9784802 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com