Basic Information
Provider Information | |||||||||
NPI: | 1518069863 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TOUCHET | ||||||||
FirstName: | NICOLE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TOUCHET | ||||||||
OtherFirstName: | NICOLE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 110 W SQUANTUM ST | ||||||||
Address2: |   | ||||||||
City: | NORTH QUINCY | ||||||||
State: | MA | ||||||||
PostalCode: | 021712122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6173763000 | ||||||||
FaxNumber: | 6177741905 | ||||||||
Practice Location | |||||||||
Address1: | 110 W SQUANTUM ST | ||||||||
Address2: |   | ||||||||
City: | NORTH QUINCY | ||||||||
State: | MA | ||||||||
PostalCode: | 021712122 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6173763000 | ||||||||
FaxNumber: | 6177741905 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/05/2006 | ||||||||
LastUpdateDate: | 05/01/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 92367 | NM | Y |   | Other Service Providers | Specialist |   | 207Q00000X | 234282 | MA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | CS00210137 | 01 | NM | CSR | OTHER | BT3554020 | 01 |   | DEA | OTHER |