1265507826 NPI number — DR JOHN A DUGGAN INC

Table of content: (NPI 1265507826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265507826 NPI number — DR JOHN A DUGGAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOHN A DUGGAN INC
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:
1265507826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/22/2008
NPI Reactivation Date:
01/09/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 COURTHOUSE LN
Provider Second Line Business Mailing Address:
UNIT 1
Provider Business Mailing Address City Name:
CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-453-3541
Provider Business Mailing Address Fax Number:
978-458-3598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 COURTHOUSE LN
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-453-3541
Provider Business Practice Location Address Fax Number:
978-458-3598
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUGGAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-453-3541

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2186 , 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: 0304603 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9709959 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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