1467632315 NPI number — CLEMENT L TREMPE MD PC

Table of content: (NPI 1467632315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467632315 NPI number — CLEMENT L TREMPE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEMENT L TREMPE MD PC
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:
1467632315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 WILSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAHANT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01908-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-595-1630
Provider Business Mailing Address Fax Number:
781-599-1563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 COMMONWEALTH AVE NEW ENGLAND EYE INSTITUTE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-262-2020
Provider Business Practice Location Address Fax Number:
617-587-5518
Provider Enumeration Date:
11/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIES
Authorized Official First Name:
ZENA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIR CLINIC & BUSINESS OPS
Authorized Official Telephone Number:
617-262-2020

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  37124 , 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: M13124 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 705430 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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