Basic Information
Provider Information | |||||||||
NPI: | 1497709331 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CAPLAN | ||||||||
FirstName: | HUBERT | ||||||||
MiddleName: | IRWIN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 372 WASHINGTON ST | ||||||||
Address2: | THE MARINO FOUNDATION, CREDENTIALING OFFICE | ||||||||
City: | WELLESLEY | ||||||||
State: | MA | ||||||||
PostalCode: | 024816202 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7812355200 | ||||||||
FaxNumber: | 7812351103 | ||||||||
Practice Location | |||||||||
Address1: | 372 WASHINGTON ST | ||||||||
Address2: | THE MARINO FOUNDATION, CREDENTIALING OFFICE | ||||||||
City: | WELLESLEY | ||||||||
State: | MA | ||||||||
PostalCode: | 024816202 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7812355200 | ||||||||
FaxNumber: | 7812351103 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/22/2006 | ||||||||
LastUpdateDate: | 09/01/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 25300 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
ID | Type | State | Issuer | Description | 701422 | 01 | MA | TUFTS | OTHER | M21670 | 01 | MA | MEDICARE PROVIDER GROUP | OTHER |