1447248299 NPI number — OBSTETRICS,GYNECOLOGY,INFERTILITY P.C.

Table of content: ALEYAMMA MATHEW NP-C (NPI 1760911572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447248299 NPI number — OBSTETRICS,GYNECOLOGY,INFERTILITY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBSTETRICS,GYNECOLOGY,INFERTILITY 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:
1447248299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 ALLEN ST
Provider Second Line Business Mailing Address:
SUITE 402
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-4570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-773-7777
Provider Business Mailing Address Fax Number:
802-773-2867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-4570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-773-7777
Provider Business Practice Location Address Fax Number:
802-773-2867
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BEERWORTH
Authorized Official First Name:
MARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
802-773-7777

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 216-5217 . This is a "VT BC/BS GROUP ID NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1945 . This is a "GROUP CDPHP BILLING ID" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: VT9114 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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