1821104241 NPI number — PAUL S PEICOTT DPM

Table of content: PAUL S PEICOTT DPM (NPI 1821104241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821104241 NPI number — PAUL S PEICOTT DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEICOTT
Provider First Name:
PAUL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1821104241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 HIGHLAND AVE
Provider Second Line Business Mailing Address:
NORTH SHORE HEALTH SYSTEMS
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-354-4173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ESSEX CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-531-9969
Provider Business Practice Location Address Fax Number:
978-531-3745
Provider Enumeration Date:
08/21/2006

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: 213ES0103X , with the licence number:  1746 , 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: 0361461 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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