1902070568 NPI number — DOUGLAS PATCH MD PC

Table of content: (NPI 1902070568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902070568 NPI number — DOUGLAS PATCH MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS PATCH MD PC
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:
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:
1902070568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 PARKER HILL AVE
Provider Second Line Business Mailing Address:
SUITE 580
Provider Business Mailing Address City Name:
ROXBURY CROSSING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02120-2847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-264-4848
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PARKER HILL AVE
Provider Second Line Business Practice Location Address:
SUITE 580
Provider Business Practice Location Address City Name:
ROXBURY CROSSING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02120-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-264-4848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATCH
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ORTHOPAEDIC SURGEON
Authorized Official Telephone Number:
617-264-4848

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MA75726 , 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: 758540 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2531964 . This is a "AETNA / US HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 09-00839 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4396480 . This is a "AETNA INTERNATIONAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J12247 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 172736 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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