1144418328 NPI number — WILLIE J. CATER, M.D. P.C.

Table of content: (NPI 1144418328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144418328 NPI number — WILLIE J. CATER, M.D. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIE J. CATER, M.D. P.C.
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:
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:
1144418328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 55849
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:
02205-5849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-296-6622
Provider Business Mailing Address Fax Number:
617-296-4827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 DORCHESTER AVE
Provider Second Line Business Practice Location Address:
SETON MEDICAL OFFICE BLDG, SUITE 211
Provider Business Practice Location Address City Name:
DORCHESTER CENTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02124-5628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-296-6622
Provider Business Practice Location Address Fax Number:
617-296-4827
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CELLUCCI
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
781-410-9111

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  34911 , 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: 9724613 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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