1982735403 NPI number — BRENDA J. BAILLARGEON, RD, LDN

Table of content: (NPI 1982735403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982735403 NPI number — BRENDA J. BAILLARGEON, RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENDA J. BAILLARGEON, RD, LDN
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:
1982735403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENDON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01756-0506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-883-7322
Provider Business Mailing Address Fax Number:
508-883-7322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HASTINGS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01756-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-883-7322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAILLARGEON
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
508-883-7322

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  378 , 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: 0000LD0021 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000LG0002 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 39476 . This is a "HARVARD PILGRIM NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MT0225 . This is a "MEDICARE, PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000378 . This is a "TUFTS PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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