1174520563 NPI number — ANDREW J GILLIES MD

Table of content: ANDREW J GILLIES MD (NPI 1174520563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174520563 NPI number — ANDREW J GILLIES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIES
Provider First Name:
ANDREW
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1174520563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-6731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-251-2222
Provider Business Mailing Address Fax Number:
781-234-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-6731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-251-2222
Provider Business Practice Location Address Fax Number:
781-234-0279
Provider Enumeration Date:
06/30/2005

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: 207W00000X , with the licence number:  55237 , 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: 055237 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055237 . This is a "TUFTS BENEFIT ADMINISTRAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: B77257 . This is a "FIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180009329 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7538944 . This is a "HEALTHSOURSCE MASSACHUSET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055237 . This is a "TUFTS COMMONWEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15986 . This is a "HARVARD PILGRIM POS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3031535 . This is a "MASS HEALTH (DIV MED SVCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: J07034 . This is a "BS-BLUE CARE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: J07034 . This is a "BS-BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055237 . This is a "TUFTS TOTAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: J07034 . This is a "HMO BLUE/BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J07034 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08-00480 . This is a "UNITED HEALTHCARE(HMO&PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27410 . This is a "CHILDREN'S MEDICAL SECURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7538944 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000600 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 055237 . This is a "TUFTS SECURE HORIZONS" identifier . This identifiers is of the category "OTHER".




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