1952559189 NPI number — M.BERN HEMATOLOGY-ONCOLOGY, PC

Table of content: (NPI 1952559189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952559189 NPI number — M.BERN HEMATOLOGY-ONCOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M.BERN HEMATOLOGY-ONCOLOGY, 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:
1952559189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
541 MASON BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04649-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-497-2996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 LINCOLN ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-8264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-620-0465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CORBETT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING REPRESENTATIVE
Authorized Official Telephone Number:
207-497-2996

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MA34117 , 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: 7799223 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952559189 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952559189 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 693116 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952559189 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952559189 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1952559189 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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