1861441131 NPI number — RAYMOND A SMITH M.D.

Table of content: RAYMOND A SMITH M.D. (NPI 1861441131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861441131 NPI number — RAYMOND A SMITH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
RAYMOND
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1861441131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
690 CANTON ST
Provider Second Line Business Mailing Address:
SUITE 325
Provider Business Mailing Address City Name:
WESTWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02090-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-407-7713
Provider Business Mailing Address Fax Number:
781-407-0998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690 CANTON ST
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
WESTWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02090-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-407-7713
Provider Business Practice Location Address Fax Number:
781-407-0998
Provider Enumeration Date:
05/06/2006

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: 207L00000X , with the licence number:  54952 , 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: 277195 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3009785 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J05570 . This is a "BLUE CROSS/ BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 709103 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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