1710334792 NPI number — CHRISTINA BROWN MA

Table of content: CHRISTINA BROWN MA (NPI 1710334792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710334792 NPI number — CHRISTINA BROWN MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
CHRISTINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

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:
1710334792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MECHANIC ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01608-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-792-5400
Provider Business Mailing Address Fax Number:
508-831-0074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PLAISTOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-373-4985
Provider Business Practice Location Address Fax Number:
508-831-0074
Provider Enumeration Date:
05/19/2016

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y10400 . This is a "GROUP MEDICARE #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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