1992747141 NPI number — KATHY DAVIS GAUTHIER PA-C

Table of content: KATHY DAVIS GAUTHIER PA-C (NPI 1992747141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992747141 NPI number — KATHY DAVIS GAUTHIER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAUTHIER
Provider First Name:
KATHY
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1992747141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 FRANCIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-6110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-732-5500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 FRANCIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-732-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

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: 207RC0000X , with the licence number:  1054 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 001054 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA4555 , 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: 010504 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290001054CT05 . This is a "ANTHEM/ECCD:06-1616101" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V7415 . This is a "HELATHNET/ECCD:06-1616101" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-1616101 . This is a "COMM. HEALTH NETWORK/ECCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 06-1049086 . This is a "COMM. HEALTH NETWORK/ECCG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290001054CT03 . This is a "ANTHEM/ECCGH:06-1049086" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V7414 . This is a "HEALTHNET/ECCG:06-1049086" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500HBC444CT01 . This is a "ANTHEM:HOSP-BASED ECCD" identifier . This identifiers is of the category "OTHER".




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