1013923101 NPI number — DR. CARL JOHN VANDERPUTTEN DO

Table of content: DR. CARL JOHN VANDERPUTTEN DO (NPI 1013923101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013923101 NPI number — DR. CARL JOHN VANDERPUTTEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERPUTTEN
Provider First Name:
CARL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1013923101
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:
67 SHAKER RD
Provider Second Line Business Mailing Address:
STE 8
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04039-9640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-657-5339
Provider Business Mailing Address Fax Number:
207-657-5136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SOUTH ST
Provider Second Line Business Practice Location Address:
HARRINGTON MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
SOUTHBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01550-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-765-9771
Provider Business Practice Location Address Fax Number:
508-765-3147
Provider Enumeration Date:
07/31/2006

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: 207P00000X , with the licence number:  80946 , 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)