1972578185 NPI number — MARTHA WADLEIGH MD

Table of content: MARTHA WADLEIGH MD (NPI 1972578185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972578185 NPI number — MARTHA WADLEIGH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WADLEIGH
Provider First Name:
MARTHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1972578185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 BINNEY ST
Provider Second Line Business Mailing Address:
DANA 1B25
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-632-6685
Provider Business Mailing Address Fax Number:
617-582-8202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 BINNEY ST
Provider Second Line Business Practice Location Address:
DANA 1B25
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-632-6685
Provider Business Practice Location Address Fax Number:
617-582-8202
Provider Enumeration Date:
02/21/2006

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: 207RX0202X , with the licence number:  209746 , 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: 3600443 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2061956 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2069156 . This is a "MASSHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J27416 . This is a "INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9213265 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA13675 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J27416 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209746 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J27416 . This is a "MA BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3634389 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J27416 . This is a "BC ELECT" identifier . This identifiers is of the category "OTHER".




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