1487614251 NPI number — DUGALD H MUNRO MD

Table of content: DUGALD H MUNRO MD (NPI 1487614251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487614251 NPI number — DUGALD H MUNRO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNRO
Provider First Name:
DUGALD
Provider Middle Name:
H
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:
1487614251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 E MANNING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-272-2020
Provider Business Mailing Address Fax Number:
401-421-5979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 WAMPONOAG TRL
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-437-0500
Provider Business Practice Location Address Fax Number:
401-433-3581
Provider Enumeration Date:
03/25/2006

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:  MD03705 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: 219972 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 15263RIH . This is a "HARVARD PILGRIM HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003705 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001588 . This is a "BLUE CROSS BLUE SHIELD OF RI-BLUECHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 185 . This is a "BLUE CROSS BLUE SHIELD OF RHODE ISLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000ZB6419 . This is a "BLUE CROSS BLUE SHIELD OF MASSACHUSETTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 08-00104 . This is a "UNITED HEALTHCARE OF NEW ENGLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9000185 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00470561 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com