1033123641 NPI number — DAWN MARIE PICOTTE MD

Table of content: DAWN MARIE PICOTTE MD (NPI 1033123641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033123641 NPI number — DAWN MARIE PICOTTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICOTTE
Provider First Name:
DAWN
Provider Middle Name:
MARIE
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:
1033123641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33902-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-343-2062
Provider Business Mailing Address Fax Number:
239-424-4186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12550 NEW BRITTANY BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-343-9190
Provider Business Practice Location Address Fax Number:
239-343-9193
Provider Enumeration Date:
07/28/2006

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: 2084P0800X , with the licence number:  MD09177 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: MD09177 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: ME112295 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15-36801 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 400245 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1104801349 . This is a "BUTLER HOSPITAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25184-8 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 006741700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093831646 . This is a "BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9025184 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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